ETA-9059 verfification results

Verification Results U. S. Department of Labor

Work Opportunity Tax Credit Employment and Training Administration

Audit Summary Worksheet (For SWA Internal Use Only)

S tate: Quarter Ending: OMB No. 1205-0371 Expiration Date: 8/31/09

A . CERTIFICATIONS ISSUED

1. Universe Size

2. Sample Size

3. Number Invalid

4. Percent Invalid (Complete Lines No. 5 & 6 ONLY

if the entry for Line No. 4 is 5 percent or greater.)

5. Number Invalid - 2nd Sample

6. P ercent Invalid - 2nd Sample

Comments:

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Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents' obligation to reply to this requirement is mandatory (P.L. 104-188). Public reporting burden for this collection of information is estimated to average 1 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to the U.S. Department of Labor. Office of Workforce Investment, Division of Adult Services, Room C-4514, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0371).

7 . Name and Title of Responsible Official: 8. Signature: 9. Date Signed:

Page 1 of 2 ETA Form 9059 (Rev. Dec. 2006)