Information Collection

ETA-9042, 9042a

IC 13133 under ICR 202008-1205-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 ETA-9042, 9042a	Form and Instruction
ETA 9042 Petition for TAA ETA-9042 Petition for TAA - English.docx	Form and Instruction
ETA 9042 Petition for TAA Spanish ETA-9042 Petition for TAA - Spanish.docx	Form and Instruction
ETA-9042 Webapp Test Petition.pdf WepApp Test Petition	IC Document
ETA-9042 EBSS Petition Screenshots.docx EBSS Petition Screen Shots	IC Document

IC Title:

ETA-9042, 9042a

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

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 for TAA	ETA-9042 Petition for TAA - English.docx		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9042	Petition for TAA Spanish	ETA-9042 Petition for TAA - Spanish.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 80 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	1,200	996	204
Annual IC Time Burden (Hours)	400	332	68
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
WepApp Test Petition	ETA-9042 Webapp Test Petition.pdf	09/10/2020
EBSS Petition Screen Shots	ETA-9042 EBSS Petition Screenshots.docx	09/10/2020

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