Information Collection

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

IC 13133 under ICR 201312-1205-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Petition, ETA-9042 and 9042a, individuals (three or more workers)	Form and Instruction
ETA 9042 Petition ETA-9042.doc	Form and Instruction
ETA 9042a Petition, in Spanish ETA-9042a (Spanish).doc	Form and Instruction
ETA 9042 Petition ETA-9042 reversion changes to online petition screens.doc	Form and Instruction
Revised_Petition_Forms_to_File_for_Trade_Adjustment_Assistance(20111129).doc TEGL	IC Document

IC Title:

Petition, ETA-9042 and 9042a, 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	ETA-9042.doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042a	Petition, in Spanish	ETA-9042a (Spanish).doc	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042	Petition	ETA-9042 reversion changes to online petition screens.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
TEGL	Revised_Petition_Forms_to_File_for_Trade_Adjustment_Assistance(20111129).doc	11/29/2011

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