Information Collection

SCSEP Unsubsidized Employment Form (State)

IC 181009 under ICR 201411-1205-004 · OMB 1205-0040.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0040 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9122 SCSEP Unsubsidized Employment Form (State)	Form
ETA-9122 SCSEP Unsubsidized Employment Form SPARQ UnsubEmp Form ETA-9122_4 18 11.pdf	Form

IC Title:

SCSEP Unsubsidized Employment Form (State)

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 Part 641 (To search for a specific CFR, visit the Code of Federal Regulations.)

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
Form	ETA-9122	SCSEP Unsubsidized Employment Form	SPARQ UnsubEmp Form ETA-9122_4 18 11.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 36

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	Previously Approved
Annual Number of Responses for this IC	6,000	-6,420	12,420
Annual IC Time Burden (Hours)	600	-642	1,242
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.