Information Collection

SCSEP Participant Data Form (State)

IC 43785 under ICR 201010-1205-008 · OMB 1205-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9120 SCSEP Participant Data Form (State)	Form
ETA-9120 SPARQ Participant Form SPARQ Participant Form ETA-9120_4 19 10.pdf	Form

IC Title:

SCSEP Participant Data Form (State)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR Part 641 (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA-9120	SPARQ Participant Form	SPARQ Participant Form ETA-9120_4 19 10.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 56

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	31,200	3,642	27,558
Annual IC Time Burden (Hours)	6,240	728	5,512
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.