Information Collection

State Recordkeeing

IC 221368 under ICR 201608-1205-006 · OMB 1205-0526.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0526 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Periods for Reporting - Annual and Quarterly FINAL.xlsx	Instruction
Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Instruction
Effectiveness in Serving Employers Specs - 4.20.2016 FINAL.doc	Instruction
ETA-9170 WIOA PIRL ETA 9170 - WIOA PIRL_Final_V22_062716.xlsx	Form

IC Title:

State Recordkeeing

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 677

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
Instruction			Periods for Reporting - Annual and Quarterly FINAL.xlsx	Yes	No	Printable Only
Instruction			Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Yes	No	Printable Only
Form	ETA-9170	WIOA PIRL	ETA 9170 - WIOA PIRL_Final_V22_062716.xlsx	Yes	Yes	Fillable Fileable
Instruction			Effectiveness in Serving Employers Specs - 4.20.2016 FINAL.doc	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 213

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 New Statute
Annual Number of Responses for this IC	16,210,211	16,210,211
Annual IC Time Burden (Hours)	4,254,436	4,254,436
Annual IC Cost Burden (Dollars)	26,147,067	26,147,067

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.