Information Collection

Job Service Complaint Reporting (ETA 8429)

IC 12963 under ICR 201605-1205-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 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

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:

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	Complaint Form	ETA 8429 Complaint Form final 6.24.16.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: 52

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
	Approved	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,500	0	-36	3,536
Annual IC Time Burden (Hours)	7,000	-1	-542	7,543
Annual IC Cost Burden (Dollars)	0	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	05/05/2016

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