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Workforce Investment Act: National Emergency Grant (NEG) Assistance-Application and Reporting Procedures
National Dislocated Workers Emergency Grant Application and Reporting Procedures
OMB: 1205-0439
IC ID: 13302
OMB.report
DOL/ETA
OMB 1205-0439
ICR 201507-1205-003
IC 13302
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0439 can be found here:
2022-08-30 - Revision of a currently approved collection
2019-09-23 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form ETA 9104
Workforce Investment Act: National Emergency Grant (NEG) Assistance-Application and Reporting Procedures
Form
ETA 9103-1 Planning Form (Regular)
Planning Form 9103-1 final 5.4.16.doc
Form
ETA 9103-2a Planning Form (Disaster-Temporary Jobs)
Planning Form 9103-2a final 5.4.16.doc
Form
ETA 9103-2b Planning Form (Disaster Workforce Development Services)
Planning Form 9103-2b final 5.4.16.doc
Form
ETA 9103-3 Planning Form (Dual Enrollment)
Planning Form 9103-3 final 5.4.16.doc
Form
ETA 9104 Quarterly Performance Report
Quarterly Performance Report Form 9104 final 5.4.16.doc
Form
ETA 9105 Employer Data Form
Employer Data Form 9105 final 5.4.16.doc
Form
ETA 9106 Project Synopsis Form
Project Synopsis Form 9106 final 5.4.16.doc
Form
ETA 9107 Project Operator Data Form
Project Operator Data Form 9107 final 5.4.16.doc
Form
Planning Form 9103(1) 2-24-15.doc
Planning Form 9103-1 (track changes)
IC Document
Planning Form 9103(2a) 2-24-15.doc
Planning Form 9103-2a (track changes)
IC Document
Planning Form 9103(2b) 2-24-15.doc
Planning Form 9103-2b (track changes)
IC Document
Planning Form 9103(3) 2-24-15.doc
Planning Form 9103-3 (track changes)
IC Document
Quarterly Performance Report Form 9104 2-24-15.doc
Quarterly Performance Report Form 9104 (track changes)
IC Document
Employer Data Form 9105 2-12-15.doc
Employer Data Form 9105 (track changes)
IC Document
Project Synopsis Form 9106 2-24-15.doc
Project Synopsis Form 9106 (track changes)
IC Document
Project Operator Data Form 9107 2-12-15.doc
Project Operator Data Form 9107 (track changes)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Workforce Investment Act: National Emergency Grant (NEG) Assistance-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
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
ETA 9104
Quarterly Performance Report
Quarterly Performance Report Form 9104 final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9105
Employer Data Form
Employer Data Form 9105 final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9106
Project Synopsis Form
Project Synopsis Form 9106 final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9107
Project Operator Data Form
Project Operator Data Form 9107 final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9103-1
Planning Form (Regular)
Planning Form 9103-1 final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9103-2a
Planning Form (Disaster-Temporary Jobs)
Planning Form 9103-2a final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9103-2b
Planning Form (Disaster Workforce Development Services)
Planning Form 9103-2b final 5.4.16.doc
Yes
Yes
Fillable Fileable
Form
ETA 9103-3
Planning Form (Dual Enrollment)
Planning Form 9103-3 final 5.4.16.doc
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
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 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,587
0
102
0
0
1,485
Annual IC Time Burden (Hours)
1,086
0
80
0
0
1,006
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Planning Form 9103-1 (track changes)
Planning Form 9103(1) 2-24-15.doc
05/04/2016
Planning Form 9103-2a (track changes)
Planning Form 9103(2a) 2-24-15.doc
05/04/2016
Planning Form 9103-2b (track changes)
Planning Form 9103(2b) 2-24-15.doc
05/04/2016
Planning Form 9103-3 (track changes)
Planning Form 9103(3) 2-24-15.doc
05/04/2016
Quarterly Performance Report Form 9104 (track changes)
Quarterly Performance Report Form 9104 2-24-15.doc
05/04/2016
Employer Data Form 9105 (track changes)
Employer Data Form 9105 2-12-15.doc
05/04/2016
Project Synopsis Form 9106 (track changes)
Project Synopsis Form 9106 2-24-15.doc
05/04/2016
Project Operator Data Form 9107 (track changes)
Project Operator Data Form 9107 2-12-15.doc
05/04/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.