View Information Collection (IC)

View Information Collection (IC)

IC Title:	Comprehensive Services Program report (Form ETA-9084) (Not-for-Profit Grantees)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 652

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9084	General Reporting Instructions for the Comprehensive Services Program Report ( and Standardized Participant Information Record Data	ETA 9084 General Reporting Instructions September 5 20131final.doc		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/ETA - 15	FR Citation: 67 FR 16898

Number of Respondents: 41	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	164	0	164	0	0	0
Annual IC Time Burden (Hours)	3,936	0	3,936	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 9084 Comprehensive Services Report Yellow Highlights, Vets	ETA 9084 General Reporting Instructions September 5 20131.doc	09/17/2013

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