View Information Collection (IC)

View Information Collection (IC)

IC Title:	Petition, ETA-9042 and 9042a, individuals (three or more workers)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 90

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9042	Petition	ETA-9042 English Petition (2015-08-31).docx		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042a	Petition, in Spanish	ETA-9042A Spanish Petition.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042	Petition	ETA-9042 reversion changes to online petition screens.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:	FR Citation:

Number of Respondents: 844	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

	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	844	0	0	0	0	844
Annual IC Time Burden (Hours)	352	0	0	0	0	352
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
9042	ETA-9042 English Petition mark-up for 2015.doc	07/27/2015
9042A	ETA-9042A Spanish Petition mark-up for 2015.doc	07/27/2015

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