Information Collection

WIOA Annual State Performace Reporting

IC 220951 under ICR 201604-1205-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9169 WIOA Annual State Performace Reporting	Form and Instruction
Appendix D - Periods for Reporting Annuall and Quarterly FINAL.xlsx	Instruction
Appendix E - Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Instruction
ETA-9169 WIOA Statewide and Local Performance Report Template and Appendix C - ETA-9169 WIOA Statewide and Local Performance Report Template and Specifications FINAL.xlsx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Mandatory

CFR Citation: 20 CFR 667

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-9169	WIOA Statewide and Local Performance Report Template and Specifications	Appendix C - ETA-9169 WIOA Statewide and Local Performance Report Template and Specifications FINAL.xlsx	Yes	Yes	Fillable Fileable
Instruction			Appendix D - Periods for Reporting Annuall and Quarterly FINAL.xlsx	Yes	No	Printable Only
Instruction			Appendix E - Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 208

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
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	208	208
Annual IC Time Burden (Hours)	928	928
Annual IC Cost Burden (Dollars)	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.