View Information Collection (IC)

View Information Collection (IC)

IC Title:	WIOA Statewide Performance Report Template and WIOA Local Performance Report Template IC (ETA-9169)	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 677

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Instructions - WIOA Wage Conversion Chart - 123020.xlsx		Yes	No	Printable Only
Instruction			Effectiveness in Serving Employers Specs - 123020.docx		Yes	No	Printable Only
Form	ETA 9169	WIOA Statewide and Local Performance Report Template	ETA_9169 2.7.24 CLEAN.xlsx		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: 249	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	249	0	0	0	0	249
Annual IC Time Burden (Hours)	1,110	0	0	0	0	1,110
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
WOIA Statewide and Local Performance Report - track changes	ETA_9169 2.7.24.xlsx	02/09/2024

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