UCX claimants selected for an RESEs

Reemployment Services and Eligibility Assessment Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0456 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9128X UCX claimants selected for an RESEs Form and Instruction
ETA 9128X Section IV Special Programs ETA 9128 X.docx Form and Instruction
ETA 9129X ETA 9129 X Reemployment Services and Eligibility Assessm ETA 9129 X.docx Form and Instruction
Facsimile of Form ETA 9129 w-track changes.docx Facsimile of Form ETA 9129 w-track changes IC Document
SectionIV_SpecialPrograms_ETA 9128-DW-track changes.doc SectionIV SpecialPrograms_ETA 9128-DW-track changes IC Document

Information Collection (IC) Details

IC Title:	UCX claimants selected for an RESEs	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 9128X	Section IV Special Programs	ETA 9128 X.docx		Yes	Yes	Fillable Printable
Form and Instruction	ETA 9129X	ETA 9129 X Reemployment Services and Eligibility Assessments (RESEAs) for Unemployment Compensation for Ex-Service members (UCX) Outcomes	ETA 9129 X.docx		Yes	Yes	Fillable Fileable

Line of Business: Income Security

Subfunction: Unemployment Compensation

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	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	392	180	212
Annual IC Time Burden (Hours)	196	90	106
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Facsimile of Form ETA 9129 w-track changes	Facsimile of Form ETA 9129 w-track changes.docx	02/26/2016
SectionIV SpecialPrograms_ETA 9128-DW-track changes	SectionIV_SpecialPrograms_ETA 9128-DW-track changes.doc	02/26/2016

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