Information Collection

Complaint Form

IC 12963 under ICR 201503-1205-014 · OMB 1205-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0039 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-8429 Complaint Form	Form
ETA-8429 MSFW Complaint Form 8429 Complaint Form 4 13 2015.docx	Form
8429 Complaint Form Updated TRACKED CHANGES.docx ETA 8429 track changes	IC Document

IC Title:

Complaint Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 658

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-8429	MSFW Complaint Form	8429 Complaint Form 4 13 2015.docx		Yes	Yes	Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/ETA-15, published April 8, 2002

FR Citation: 67 FR 16898

Number of Respondents: 3,536

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,536	536	3,000
Annual IC Time Burden (Hours)	7,543	1,143	6,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ETA 8429 track changes	8429 Complaint Form Updated TRACKED CHANGES.docx	04/13/2015

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