Job Service Complaint Third Party Disclosure

Migrant and Seasonal Farmworker Monitoring Report and Complaint/Apparent Violation Form

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0039 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 8429 Job Service Complaint Third Party Disclosure 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

IC Title:	Job Service Complaint Third Party Disclosure	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 658 20 CFR 653.109

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

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/ETA-15 April 8 2002	FR Citation: 67 FR 16898

Number of Respondents: 3,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,500	-36	3,536
Annual IC Time Burden (Hours)	1,750	1,279	471
Annual IC Cost Burden (Dollars)	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.