Information Collection

YouthBuild Grantee Quarterly Reports and Housing Site Report

IC 180934 under ICR 201409-1205-004 · OMB 1205-0464.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0464 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9136 YouthBuild Grantee Quarterly Reports and Housing Site Report	Form and Instruction
ETA 9136 MIS System, Quarterly Reports Screenshot of YB PRA statement and exp date (2015).docx	Form and Instruction
ETA 9143, Part C Annual Housing Census Part-C_Continuation Form_Work Site Form with Annual Housing Census_Attch_2A_5-11-2015_rev_tr_5-29-15.xlsx	Form
ETA 9143 Part A Work Site Description Form with Annual Housing Census Part-A_Work Site Form with Annual Housing Census_5-11-2015_rev_tr_5-29-15.xlsx	Form
ETA 9143 Part B Individual Work Site Project Estimate Part-B_Work Site Form with Annual Housing Census_5-11-2015_rev_tr_5-29-15.xlsx	Form
ETA 9143, Part C - Work Site Description Form with Annual Housing Census - Part-C_Work Site Form with Annual Housing Census_5-11-2015_rev_tr_5-29-15(8).xlsx	Form
National_Quarterly_Performance_Report_5-28-2015.pdf National Standard Quarterly Performance Report	IC Document

IC Title:

YouthBuild Grantee Quarterly Reports and Housing Site Report

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 672

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 9136	MIS System, Quarterly Reports	Screenshot of YB PRA statement and exp date (2015).docx	Yes	Yes	Fillable Fileable
Form	ETA 9143, Part C	Annual Housing Census	Part-C_Continuation Form_Work Site Form with Annual Housing Census_Attch_2A_5-11-2015_rev_tr_5-29-15.xlsx	Yes	Yes	Fillable Fileable Signable
Form	ETA 9143 Part A	Work Site Description Form with Annual Housing Census	Part-A_Work Site Form with Annual Housing Census_5-11-2015_rev_tr_5-29-15.xlsx	Yes	Yes	Fillable Fileable Signable
Form	ETA 9143 Part B	Individual Work Site Project Estimate	Part-B_Work Site Form with Annual Housing Census_5-11-2015_rev_tr_5-29-15.xlsx	Yes	Yes	Fillable Fileable Signable
Form	ETA 9143, Part C - Continuation	Work Site Description Form with Annual Housing Census - Continuation	Part-C_Work Site Form with Annual Housing Census_5-11-2015_rev_tr_5-29-15(8).xlsx	Yes	Yes	Fillable Fileable Signable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	2,000	-35	2,035
Annual IC Time Burden (Hours)	25,800	-2,507	28,307
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
National Standard Quarterly Performance Report	National_Quarterly_Performance_Report_5-28-2015.pdf	05/29/2015

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