Information Collection

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

IC 13133 under ICR 201012-1205-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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, automated vers OMB_9042_Screens.xls	Form and Instruction
ETA9042 Petition Petition ETA 9042.docx	Form and Instruction
ETA 9042a Petition in Spanish Petition_Spanish ETA-9042a.doc	Form and Instruction
ETA - 9042a(1) Petition, screens indicating reversions to 2002 version OMB_9042_Electronic.doc	Form and Instruction

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:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9042	Petition For Trade Adjustment Assistance, automated version	OMB_9042_Screens.xls	Yes	Yes	Fillable Fileable
Form and Instruction	ETA9042	Petition	Petition ETA 9042.docx	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042a	Petition in Spanish	Petition_Spanish ETA-9042a.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA - 9042a(1)	Petition, screens indicating reversions to 2002 version	OMB_9042_Electronic.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: 844

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	844	844
Annual IC Time Burden (Hours)	352	352
Annual IC Cost Burden (Dollars)	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.