Experience Rating Report

ICR 202108-1205-001

OMB: 1205-0164

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2021-09-28
Supplementary Document
2021-09-28
Supporting Statement A
2021-08-02
IC Document Collections
IC ID
Document
Title
Status
13005 Modified
ICR Details
1205-0164 202108-1205-001
Received in OIRA 201807-1205-004
DOL/ETA
Experience Rating Report
Extension without change of a currently approved collection   No
Regular 09/28/2021
  Requested Previously Approved
36 Months From Approved 11/30/2021
53 53
27 27
0 0

The ETA-204 provides data to ETA for the study of seasonality, employment or payroll fluctuations, and stabilization, expansion or contraction in operations on employment experience. The data are used to provide an indication of whether solvency problems exist in the State's Trust Fund accounts and in analyzing factors that give rise to solvency problems. The data are also used to complete the Experience Rating Index.

US Code: 42 USC 503(a)(6) Name of Law: Social Security Act
  
None

Not associated with rulemaking

  86 FR 15721 03/24/2021
86 FR 53689 09/28/2021
No

1
IC Title Form No. Form Name
Experience Rating Report ETA 204 Experience Rating Report

  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 53 53 0 0 0 0
Annual Time Burden (Hours) 27 27 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$35,182
No
    No
    No
No
No
No
No
Emily St. Onge 202 693-2605 st.onge.emily@dol.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
09/28/2021


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