Information Collection

Beneficiary Choice Quarterly Performance Report

IC 182164 under ICR 200809-1205-004 · OMB 1205-0455.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0455 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9140-A Beneficiary Choice Quarterly Performance Report	Form
ETA-9140-A Bene-Choice NewCase.doc	Form and Instruction
ETA-9140-A Bene-Choice Case Screen Shots.doc	Form and Instruction
ETA-9140-A Beneficiary Choice Quarterly Performance Report Sample-Standardized-PRI-Performance-Report- 10 05 07.xls	Form

IC Title:

Beneficiary Choice Quarterly Performance Report

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA-9140-A	Beneficiary Choice Quarterly Performance Report	Sample-Standardized-PRI-Performance-Report- 10 05 07.xls	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9140-A	Bene-Choice	NewCase.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9140-A	Bene-Choice	Case Screen Shots.doc	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 5

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	20	0	20
Annual IC Time Burden (Hours)	80	-240	320
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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