Information Collection

ETA-9042, 9042a

IC 13133 under ICR 202105-1205-006 · 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⚠️ Notice: This information collection may be referencing outdated material.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 - Reversion 2021_Online Form.docx	Form and Instruction
ETA-9042 Petition for TAA Spanish ETA-9042 Petition for TAA - Spanish - Reversion 2021.docx	Form and Instruction
ETA-9042 Petition for TAA - English - Reversion 2021_Online Form.docx Screenshots	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 - Reversion 2021_Online Form.docx		Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9042	Petition for TAA Spanish	ETA-9042 Petition for TAA - Spanish - Reversion 2021.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	Previously Approved
Annual Number of Responses for this IC	1,200	1,200
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Screenshots	ETA-9042 Petition for TAA - English - Reversion 2021_Online Form.docx	05/25/2021

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