Information Collection

States/Territories Reporting to the Federal Government IC (ETA 9169)

IC 221306 under ICR 202012-1205-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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
Instructions - WIOA Wage Conversion Chart - 123020.xlsx Instruction
Instructions - WIOA Wage Conversion Chart - 123020.xlsx Instruction
Effectiveness in Serving Employers Specs - 123020.docx Instruction
Effectiveness in Serving Employers Specs - 123020.docx Instruction
ETA-9169 WIOA Statewide and Local Performance Report Template ETA_9169 10.15.20.xlsx Form
ETA 9169 WIOA Statewide and Local Performance Report Template ETA_9169 4.14.21.xlsx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	States/Territories Reporting to the Federal Government IC (ETA 9169)	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: Modified

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			Instructions - WIOA Wage Conversion Chart - 123020.xlsx	Yes	No	Printable Only
Instruction			Effectiveness in Serving Employers Specs - 123020.docx	Yes	No	Printable Only
Form	ETA 9169	WIOA Statewide and Local Performance Report Template	ETA_9169 4.14.21.xlsx	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 249	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	249	-2	251
Annual IC Time Burden (Hours)	1,110	-8	1,118
Annual IC Cost Burden (Dollars)	0	0	0

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.