Information Collection

Supplemental Youth Services Program Report (Tribal Govermment Grantees)

IC 45442 under ICR 201212-1205-006 · OMB 1205-0422.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0422 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
INA-SPIR-Specifications- may 2013.doc	Instruction
ETA 9084 General Reporting Instructions for the Comprehensive Ser ETA 9084 General Reporting Instructions September 5 20131final.doc	Form and Instruction
ETA 9084 General Reporting Instructions September 5 20131.doc ETA 9084 Services Program Report Added Fields Yellow Highlighted	IC Document

IC Title:

Supplemental Youth Services Program Report (Tribal Govermment Grantees)

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 652

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
Instruction			INA-SPIR-Specifications- may 2013.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9084	General Reporting Instructions for the Comprehensive Services Program Report and Standardized Participant Information Record Data	ETA 9084 General Reporting Instructions September 5 20131final.doc		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/ETA-15

FR Citation: 67 FR 16898

Number of Respondents: 81

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
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	324	-6,483	-166	6,973
Annual IC Time Burden (Hours)	7,776	-20,194	-682	28,652
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ETA 9084 Services Program Report Added Fields Yellow Highlighted	ETA 9084 General Reporting Instructions September 5 20131.doc	09/17/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.