Information Collection

ETA-9042a and 9042A-1 Petition, individuals (three or more workers)

IC 13133 under ICR 200904-1205-009 · OMB 1205-0342.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0342 can be found here:

Documents and Forms

Document Name Document Type
Form ETA-9042 ETA-9042a and 9042A-1 Petition, individuals (three or more workers) Form and Instruction
ETA-9042 Petition for Trade Adjustment Assistance 9042 4_22_09.doc www.doleta.gov/tradeact Form and Instruction
ETA-9042a Petition for Trade Adjustment Assistance, Spanish versio 9042a 4_22_09.doc www.doleta.gov/tradeact Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	ETA-9042a and 9042A-1 Petition, 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 for Trade Adjustment Assistance	9042 4_22_09.doc	www.doleta.gov/tradeact	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9042a	Petition for Trade Adjustment Assistance, Spanish version	9042a 4_22_09.doc	www.doleta.gov/tradeact	Yes	No	Fillable Printable

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	Previously Approved
Annual Number of Responses for this IC	844	250	594
Annual IC Time Burden (Hours)	352	104	248
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.