Information Collection

Certification Workload and Characteristic of Certified Individuals

IC 239192 under ICR 202308-1205-002 · OMB 1205-0371.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0371 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9065 Certification Workload and Characteristic of Certified Individuals	Form and Instruction
Form ETA-9065 Certification Workload and Characteristic of Certified Individuals	Form and Instruction
ETA-9065 Audit Summary Worksheet ETA_Form_9065_Audit_Summary_Wrksht_ADVR.pdf	Form and Instruction
ETA-9065 Audit Summary Worksheet ETA_Form_9065_Audit_Summary_Wrksht_ADVR.pdf	Form and Instruction
ETA Form 9058 Certification Workload and Characteristics of Certified ETA_Form_9058_WOTC_Report_1_Certification_Workload_Characteristics_of_Certified_Individuals.pdf	Form and Instruction
ETA Form 9058 Certification Workload and Characteristics of Certified ETA_Form_9058_WOTC_Report_1_Certification_Workload_Characteristics_of_Certified_Individuals.pdf	Form and Instruction
ETA Form 9058 - redline edits.rtf Form 9058 - Tracked Changes	IC Document
ETA Form 9058 - redline edits.rtf Form 9058 - Tracked Changes	IC Document

IC Title:

Certification Workload and Characteristic of Certified Individuals

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

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-9065	Audit Summary Worksheet	ETA_Form_9065_Audit_Summary_Wrksht_ADVR.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	ETA Form 9058	Certification Workload and Characteristics of Certified Individuals	ETA_Form_9058_WOTC_Report_1_Certification_Workload_Characteristics_of_Certified_Individuals.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: 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
	Approved	Previously Approved
Annual Number of Responses for this IC	424	424
Annual IC Time Burden (Hours)	424	424
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Form 9058 - Tracked Changes	ETA Form 9058 - redline edits.rtf	02/14/2023

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