Information Collection

WIOA Annual State Performance Reporting

IC 221306 under ICR 201906-1205-002 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Instruction
Effectiveness in Serving Employers Specs - 4.20.2016 FINAL.doc	Instruction
ETA-9169 WIOA Statewide and Local Performance Report Template ETA_9169 - 5.20.2019 FINAL.xlsx	Form
ETA-9169_(changes) 12.4.17.xlsx Amended Joint Report_ETA-9169	IC Document
ETA_9169 non-material change red-lined version 2019-06-10.xlsx Amended Joint Report ETA-9169	IC Document

IC Title:

WIOA Annual State Performance Reporting

Agency IC Tracking Number:

Is this a Common Form? Yes

IC Status: Modified

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			Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Yes	No	Printable Only
Form	ETA-9169	WIOA Statewide and Local Performance Report Template	ETA_9169 - 5.20.2019 FINAL.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: 251

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	Previously Approved
Annual Number of Responses for this IC	251	251
Annual IC Time Burden (Hours)	1,118	1,118
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Amended Joint Report_ETA-9169	ETA-9169_(changes) 12.4.17.xlsx	12/29/2017
Amended Joint Report ETA-9169	ETA_9169 non-material change red-lined version 2019-06-10.xlsx	06/20/2019

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