Information Collection

Petition, ETA 9042 and 9042a, filled out by state/local workforce staff

IC 187430 under ICR 201905-1205-011 · OMB 1205-0342.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0342 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 9042 Petition, ETA 9042 and 9042a, filled out by state/local workforce staff	Form and Instruction
ETA 9042 Petition ETA-9042 Petition for TAA - English.doc	Form and Instruction
ETA 9042a Petition, in Spanish ETA-9042a Petition for TAA - Spanish.doc	Form and Instruction

IC Title:

Petition, ETA 9042 and 9042a, filled out by state/local workforce staff

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 29 CFR 90

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 and Instruction	ETA 9042	Petition	ETA-9042 Petition for TAA - English.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042a	Petition, in Spanish	ETA-9042a Petition for TAA - Spanish.doc		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 744

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
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	744	253	491
Annual IC Time Burden (Hours)	248	207	41
Annual IC Cost Burden (Dollars)	0	0	0

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.