ETA 9212 Alcohol Testing Report

U.S. Department of Labor Employment and Training Administration Office of Job Corps

ETA Form 9212 OMB Control No. 1205-0219 Expiration Date: 05/31/2025

PY [YYYY] Center Alcohol Report

1. Center Name*
2. Region*
3. Legal Name*	Enter information here
4. Title*	Enter information here
5. Email Address*	Enter information here
6. Reporting Period* Reporting Period: If you are filling this form out between October 1 and 10, 2023 - the correct corresponding reporting period is July-September 2023. The reporting period is the 3-month period prior to when the report is due.	☐ July - September 2024 ☐ October - December 2024 ☐ January - March 2025 ☐ April - June 2025
7. Number of Alcohol Tests on Suspicion*	Enter information here
8. Number of Tests Positive*	Enter information here
9. Center ID The Center ID is a 2 letter, 3 number combination. This ID also used to complete the Annual Program Description Report (Ex. AB123) If you do not know your Center ID, e-mail Leah Pan at [email protected].	Enter information here

Thank you for submitting the quarterly Alcohol Report.

A confirmation will be sent within the next 15 minutes to the e-mail address supplied above containing the submitted responses.

If you have any questions or concerns, contact Leah Pan at [email protected].

Paperwork Reduction Act Public Burden Statement: Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Respondents' obligation to complete this form is required to obtain or retain benefits (P.L. 113-128). Public reporting burden is estimated to average 8 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of Information. Send comments regarding this burden estimate to the U.S. Department of Labor, Division of Adult Services, Room S-4209, Washington, D.C. 20210 (Paperwork Reduction Project 1205-0035). Please do not submit completed forms to this address.

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