Workforce Investment Act: National Dislocated Workers Grant Application and Reporting Procedures

National Dislocated Workers Emergency Grant Application and Reporting Procedures

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0439 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9106 Workforce Investment Act: National Dislocated Workers Grant Application and Reporting Procedures Form
ETA 9105 Employer Data Employer Data Form 9105 final.doc Form
ETA 9103-1 Planning Form Planning Form 9103(1) final.doc Form
ETA 9106 Project Synopsis Form Project Synopsis Form 9106 final.doc Form
ETA 9104 Quarterly Performance Report Quarterly Performance Report Form 9104 final.doc Form
ETA 9103-2(a) Planning Form (Disaster-Temporary Jobs) Planning Form 9103(2a) final.doc Form
9103-2(b) Planning Form - Disaster Workforce Development Services Planning Form 9103(2b) final.doc Form
ETA 9107 Project Operator Data form Project Operator Data Form 9107 final.doc Form
9103-3 Planning Form, Dual Enrollment Planning Form 9103(3) final.doc Form
Employer Data Form 9105 2-12-15.doc ETA 9105 IC Document
Planning Form 9103(1) 2-24-15.doc ETA 9103(1) IC Document
Planning Form 9103(2a) 2-24-15.doc ETA 9103(2) IC Document
Planning Form 9103(2b) 2-24-15.doc eta 9103(2B) IC Document
Planning Form 9103(3) 2-24-15.doc eta 9103 (3) IC Document
Project Operator Data Form 9107 2-12-15.doc eta 9107 IC Document
Project Synopsis Form 9106 2-24-15.doc ETA 9106 project synopsis IC Document
Quarterly Performance Report Form 9104 2-24-15.doc ETA 9104 quarterly performance report IC Document

Information Collection (IC) Details

IC Title:	Workforce Investment Act: National Dislocated Workers Grant Application and Reporting Procedures	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 687.150

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA 9106	Project Synopsis Form	Project Synopsis Form 9106 final.doc	Yes	Yes	Fillable Fileable
Form	ETA 9104	Quarterly Performance Report	Quarterly Performance Report Form 9104 final.doc	Yes	Yes	Fillable Fileable
Form	ETA 9103-1	Planning Form	Planning Form 9103(1) final.doc	Yes	Yes	Fillable Fileable
Form	ETA 9105	Employer Data	Employer Data Form 9105 final.doc	Yes	Yes	Fillable Fileable
Form	ETA 9103-2(a)	Planning Form (Disaster-Temporary Jobs)	Planning Form 9103(2a) final.doc	Yes	Yes	Fillable Fileable
Form	9103-2(b)	Planning Form - Disaster Workforce Development Services	Planning Form 9103(2b) final.doc	Yes	Yes	Fillable Fileable
Form	ETA 9107	Project Operator Data form	Project Operator Data Form 9107 final.doc	Yes	Yes	Fillable Fileable
Form	9103-3	Planning Form, Dual Enrollment	Planning Form 9103(3) final.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: 159	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	1,587	89	-93	106	1,485
Annual IC Time Burden (Hours)	1,084	60	-24	42	1,006
Annual IC Cost Burden (Dollars)	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 9105	Employer Data Form 9105 2-12-15.doc	03/09/2015
ETA 9103(1)	Planning Form 9103(1) 2-24-15.doc	03/09/2015
ETA 9103(2)	Planning Form 9103(2a) 2-24-15.doc	03/09/2015
eta 9103(2B)	Planning Form 9103(2b) 2-24-15.doc	03/09/2015
eta 9103 (3)	Planning Form 9103(3) 2-24-15.doc	03/09/2015
eta 9107	Project Operator Data Form 9107 2-12-15.doc	03/09/2015
ETA 9106 project synopsis	Project Synopsis Form 9106 2-24-15.doc	03/09/2015
ETA 9104 quarterly performance report	Quarterly Performance Report Form 9104 2-24-15.doc	03/09/2015

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