Job Service Complaint Third Party Disclosure (ETA 8429)

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⚠️ Notice: This information collection may be referencing outdated material.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 (ETA 8429) Form
ETA 8429 Complaint Form ETA 8429 Complaint Form FINAL 2019-09-12.docx Form
ETA 8429 Complaint Form Proposed Track Changes 2019-09-11.docx ETA 8429 (Tracked Changes) IC Document

Information Collection (IC) Details

IC Title:	Job Service Complaint Third Party Disclosure (ETA 8429)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 653.109 20 CFR 658

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 2019-09-12.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: 3,082	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	3,082	-418	3,500
Annual IC Time Burden (Hours)	1,541	-209	1,750
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 8429 (Tracked Changes)	ETA 8429 Complaint Form Proposed Track Changes 2019-09-11.docx	09/16/2019

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