Beneficiary Choice Quarterly Performance Report

Reintegration of Ex-Offenders, Adult Reporting System

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Beneficiary Choice Quarterly Performance Report	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Removed

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection 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 %

	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-20	20
Annual IC Time Burden (Hours)	-80	80
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.