Information Collection

Job Service Complaint Reporting and Third Party Disclosure (ETA 8429)

IC 12963 under ICR 202402-1205-002 · OMB 1205-0039.

Documents and Forms

Document Name Document Type
Form ETA 8429 Job Service Complaint Reporting and Third Party Disclosure (ETA 8429) Form
ETA 8429 Compliant-Apparent Violation Form ETA 8429 Complaint-ApparentViolation Form.docx Form
ETA 8429 Compliant-Apparent Violation Form ETA 8429 Complaint-ApparentViolation Form.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Job Service Complaint Reporting and Third Party Disclosure (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	Compliant-Apparent Violation Form	ETA 8429 Complaint-ApparentViolation Form.docx		Yes	Yes	Fillable Fileable

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	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	6,164	3,547	2,617
Annual IC Time Burden (Hours)	7,705	2,471	5,234
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.