Information Collection

Eta 9055

IC 240795 under ICR 202303-1205-005 · OMB 1205-0359.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9055 ETA 9055	Form and Instruction
ETA-9055 Benefits Time Lapse & Quality SectionV_Benefits_TimeLapse_and_Quality_ETA 9055.docx	Form and Instruction

IC Title:

ETA 9055

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-9055	Benefits Time Lapse & Quality	SectionV_Benefits_TimeLapse_and_Quality_ETA 9055.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: 53

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
	Requested	Previously Approved
Annual Number of Responses for this IC	636	636
Annual IC Time Burden (Hours)	1,272	1,272
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.