Information Collection

Individual Characteristics

IC 184551 under ICR 202604-1205-001 · OMB 1205-0371.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA-9061 Individual Characteristics Form (ICF) Individual Characteristics	Form and Instruction
Form ETA-9062 Conditional Certification Form (CC) Individual Characteristics	Form and Instruction
Form ETA-9198 Employer Representative Declaration Individual Characteristics	Form and Instruction
Form ETA-9061 Individual Characteristics Form (Spanish) Individual Characteristics	Form and Instruction
ETA-9061 Individual Characteristics Form (ICF) ETA_Form_9061_Individual_Characteristics_Form.pdf	Form and Instruction
ETA-9062 Conditional Certification Form (CC) ETA_Form_9062_Conditional_Certification.pdf	Form and Instruction
ETA-9198 Employer Representative Declaration ETA_Form_9198_Employer_Representative_Declaration_Form.pdf	Form and Instruction
ETA-9061 Individual Characteristics Form (Spanish) ETA_Form_9061_Individual_Characteristics_Form.pdf	Form and Instruction
ETA Form 9061 - redline draft.docx ETA 9061 - Tracked Changes	IC Document
ETA Form 9062 - redline draft.docx ETA-9062 Tracked Changes	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-9061	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9062	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9198	Yes	Yes	Fillable Fileable
Form and Instruction	ETA-9061	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/ETA-15

FR Citation: 75 FR 6884

Number of Respondents: 9,185,562

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	9,185,562	9,185,562
Annual IC Time Burden (Hours)	3,031,235	3,031,235
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
ETA 9061 - Tracked Changes		02/14/2023
ETA-9062 Tracked Changes		02/14/2023

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

Something went wrong when downloading this file. If you have any questions, please send an email to [email protected].