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

Investigative Data Collection Requirements for the Trade Act of 1974 as amended by the Trade and Globalization Adjustment Assistance Act of 2009

⚠️ Notice: This information collection may be referencing outdated material.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, 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

Information Collection (IC) Details

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	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 %

	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

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.