Information Collection

State Recordkeeing

IC 221368 under ICR 201608-1205-008 · OMB 1205-0526.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0526 can be found here:

Documents and Forms

Document Name Document Type
Periods for Reporting - Annual and Quarterly FINAL.xlsx Instruction
Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx Instruction
Effectiveness in Serving Employers Specs - 4.20.2016 FINAL.doc Instruction
ETA-9170 WIOA PIRL ETA 9170 - WIOA PIRL_Final_V22_062716.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	State Recordkeeing	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 677

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			Periods for Reporting - Annual and Quarterly FINAL.xlsx	Yes	No	Printable Only
Instruction			Instructions - WIOA Wage Conversion Chart - 4.20.2016 FINAL.xlsx	Yes	No	Printable Only
Form	ETA-9170	WIOA PIRL	ETA 9170 - WIOA PIRL_Final_V22_062716.xlsx	Yes	Yes	Fillable Fileable
Instruction			Effectiveness in Serving Employers Specs - 4.20.2016 FINAL.doc	Yes	No	Printable Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 213	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	16,210,211	16,210,211
Annual IC Time Burden (Hours)	4,254,436	4,254,436
Annual IC Cost Burden (Dollars)	26,147,067	26,147,067

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.