Information Collection

State Recordkeeping

IC 221207 under ICR 201604-1205-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9170 State Recordkeeping	Form
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-9170 WIOA PIRL Appendix F - ETA-9170 - WIOA PIRL 4.20.2016 FINAL.xlsx	Form

IC Title:

State Recordkeeping

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Mandatory

CFR Citation:

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	ETA-9170	WIOA PIRL	Appendix F - ETA-9170 - WIOA PIRL 4.20.2016 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: 80 %

table that charts list of burden
	Requested	Program Change Due to New Statute
Annual Number of Responses for this IC	15,479,950	15,479,950
Annual IC Time Burden (Hours)	4,037,838	4,037,838
Annual IC Cost Burden (Dollars)	25,848,060	25,848,060

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.