ETA 5140 and ETA 9191

Senior Community Service Employment Program (SCSEP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0040 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 9120, ETA 9121 ETA 5140 and ETA 9191 Form and Instruction
ETA 9120, ETA 9121 SPARQ Data Collection Forms ETA 9120, ETA 9121, ETA 9122, and ETA 9123.pdf Form and Instruction
ETA 9120, ETA 9121 SPARQ Data Collection Forms ETA 9120, ETA 9121, ETA 9122, and ETA 9123.pdf Form and Instruction
ETA 9191 GPMS Data Collection Instrument ETA Form 9191 GPMS Data Collection Instrument 08032021.xlsx Form and Instruction
ETA 9191 GPMS Data Collection Instrument ETA Form 9191 GPMS Data Collection Instrument 08032021.xlsx Form and Instruction
ETA 5140 SCSEP Quarterly Progress Report ETA-5140 - SCSEP Quarterly Progress Report.pdf Form and Instruction
ETA 5140 SCSEP Quarterly Progress Report ETA-5140 - SCSEP Quarterly Progress Report.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	ETA 5140 and ETA 9191	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 42 CFR 3056 20 CFR 641.500-740 and 879(b)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 9120, ETA 9121, ETA 9022, ETA 9123	SPARQ Data Collection Forms	ETA 9120, ETA 9121, ETA 9122, and ETA 9123.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9191	GPMS Data Collection Instrument	ETA Form 9191 GPMS Data Collection Instrument 08032021.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	ETA 5140	SCSEP Quarterly Progress Report	ETA-5140 - SCSEP Quarterly Progress Report.pdf	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50,853	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50,853	8,476	42,377
Annual IC Time Burden (Hours)	152,559	25,427	127,132
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.