Information Collection

Job Service Complaint Reporting (ETA 8429)

IC 12963 under ICR 201908-1205-002 · OMB 1205-0039.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0039 can be found here:

Documents and Forms

Document Name Document Type
Form ETA 8429 Job Service Complaint Reporting (ETA 8429) Form
ETA 8429 Complaint Form ETA 8429 Complaint Form FINAL 2019-09-12.docx Form
ETA 8429 Complaint Form Proposed Track Changes 2019-09-11.docx ETA 8429 Tracked Changes IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Job Service Complaint Reporting (ETA 8429)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 653.109 20 CFR 658

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA 8429	Complaint Form	ETA 8429 Complaint Form FINAL 2019-09-12.docx		Yes	Yes	Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/ETA-15, published April 8, 2002	FR Citation: 67 FR 16898

Number of Respondents: 3,082	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,082	-418	3,500
Annual IC Time Burden (Hours)	6,164	-836	7,000
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 8429 Tracked Changes	ETA 8429 Complaint Form Proposed Track Changes 2019-09-11.docx	09/16/2019

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