Benefit Rights and Experience Report

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0177 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 218 Benefit Rights and Experience Report Form and Instruction
ETA 218 Section 1 Claimant Activity: Benefit Rights and Experien Section1_ClaimantActivity_ETA 218.doc Form and Instruction
screen shot for PRA renewal.docx ETA 218 IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Benefit Rights and Experience Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 218	Section 1 Claimant Activity: Benefit Rights and Experience	Section1_ClaimantActivity_ETA 218.doc		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 53	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	636	420	216
Annual IC Time Burden (Hours)	318	210	108
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 218	screen shot for PRA renewal.docx	03/11/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.