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Job Service Complaint Reporting (ETA 8429)
Migrant and Seasonal Farmworker Monitoring Report and Complaint/Apparent Violation Form
OMB: 1205-0039
IC ID: 12963
OMB.report
DOL/ETA
OMB 1205-0039
ICR 201605-1205-003
IC 12963
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0039 can be found here:
2024-02-13 - Revision of a currently approved collection
2023-06-30 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
Form ETA 8429
Job Service Complaint Reporting (ETA 8429)
Form
ETA 8429 Complaint Form
ETA 8429 Complaint Form final 6.24.16.docx
Form
8429 Complaint Form Updated TRACKED CHANGES.docx
ETA 8429 (track changes)
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Job Service Complaint Reporting (ETA 8429)
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 653.109
20 CFR 658
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
ETA 8429
Complaint Form
ETA 8429 Complaint Form final 6.24.16.docx
Yes
Yes
Paper Only
Federal Enterprise Architecture Business Reference Module
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:
52
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
3,500
0
0
-36
0
3,536
Annual IC Time Burden (Hours)
7,000
0
-1
-542
0
7,543
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
ETA 8429 (track changes)
8429 Complaint Form Updated TRACKED CHANGES.docx
05/05/2016
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.