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OMB Control No: 1205-0172	ICR Reference No: 202603-1205-004
Status: Received in OIRA	Previous ICR Reference No: 202304-1205-005
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Benefit Appeals Report
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 06/26/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2026
Responses	1,272	1,272
Time Burden (Hours)	1,272	1,272
Cost Burden (Dollars)	0	0

Annual Cost to Federal Government: $15,976

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination. No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination. No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

Agency Contact: Patrice Gibson 202 693-0158 gibson.patrice.a@dol.gov

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