Form ETA-6-58 Job Corps Student Allotment Determination

U.S. Department of Labor

Job Corps Student Allotment
Determination

Employment and Training Administration
OMB Approval No.: 1205-0030
Expiration Date: 02/29/04

This form must be completed for any student who desires to make an allotment.
PART I – IDENTIFICATION AND ALLOTTEE DESIGNATION
1. TO: (Name and address of Job Corps Center)

2. FROM: (Name and address of Admissions Agency)

4. Student ID

3. Name of Student (Last, First, Middle Initial)

5. Home Address of Student
No. and Street

City or P.O.

State

6. Date Travel Commenced

7. Date of Birth

Day

Day

Month

Year

ZIP Code

8. Sex (Check appropriate box)

Month

Year

Male

Female

9. Allotment (See qualification criteria on reverse)
a. I desire an allotment for the allottee indicated below: (See Item 9c) I understand that my
contribution for the allottee will be deducted from my living allowance.
Signature of Student

b. Allotment Authorized
(Check one)
Yes

No

Date Signed

c. “X” appropriate box

Allottee

Allottee/Payee

Name of Allottee or Allottee/Payee
No. and Street

Relationship
City or P.O.

State

Guardian of:

Signature of Allottee or Allottee/Payee

d. Allottment Amount

10.

Student’s
Contribution

$

Government
Contribution

$

Total
Allotment

$

ZIP Code

Date (Day, Month, Year)

The above information is true and correct to the best of my knowledge and belief.

11. Typed Name of Agent or Representative
12. Signature of Agent or Representative

Date (Day, Month, Year)

PART II – APPEAL OF ALLOTMENT DISALLOWANCE
1. It is requested that the original determination of non-entitlement to an allotment be reviewed. The student feels that he/she is entitled to make an
allotment and makes the following statement: (if additional space is required, continue on blank paper and attach to this form.)

2.

The above information is true and correct to the best of my knowledge and belief.

3. Signature of Student

4. Typed Name and Signature of Authorized Official

Date (Day, Month, Year)

Persons are not required to respond to this collection of information unless it displays a currently valid OMB control number. Public reporting burden
for this collection of information is estimated to average 3 minutes per response, including the time for reviewing instructions, searching existing
data sources, gathering and maintaining the data needed, and completing and reviewing the information. Send comments regarding this burden
estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Labor, Office
of Job Corps, Room N-4463, 200 Constitution Avenue, N.W., Washington, D.C. 20210 (Paperwork Reduction Project 1205-0030).
Page 1 of 2

ETA 6-58 (Rev. Feb. 2001)

PART III – APPEAL DETERMINATION
1. As requested in Part II, a review of the original determination has been made, the qualifying criteria,
the student’s statement and other information available to this office have been considered.

3. Allotment Approved For:

2. Date
Day

Month

Year

Relationship

Name of Allottee or Allottee/Payee
No. and Street

City or P.O.

State

ZIP Code

4. Remarks

5. Typed Name and Signature of Admissions Agency Representative

6. Name of Admissions Agency

Address of Admissions Agency (include ZIP Code)

Criteria for Allotment Assignment

The applicant is the parent of a dependent child or otherwise has formal child support responsibility, and
has submitted appropriate documentation to that effect. Appropriate documentation may consist of, but is
not necessarily limited to, copies of: birth certificates; adoption papers; child support decrees or other court
documents; foster care agreements; tax returns; public assistance records; school records; or other official
documents issued by agencies of Federal, State or local government.

Page 2 of 2

ETA 6-58 (Rev. Feb. 2001)

Form Instructions

ETA 6-58 Job Corps Student Allotment Determination
Purpose:

To obtain information from the applicant as to the allottee designation.
To document the applicant’s claim to qualify for allotment.

Originator:

Job Corps Admissions Counselor/Job Corps Center.

Frequency:

Once for each applicant who accepts Center assignment, is qualified and wants to
make an allotment.

Distribution:

Applicant to Center
Original: Send with applicant to assigned Center
Copy: Admissions Counselor
Applicant refuses assignment
Copies 1 and 2: to Admissions Counselor

Disposition:

Original: Job Corps Center
Copy: Admissions Counselor

General Instructions:

Admissions Counselor should make every effort to obtain documentation to
verify that the applicant is qualified to make an allotment.
Complete this form only for an eligible applicant according to the allotment
criteria.

Detailed Instructions:

Part I - Identification and Allottee Designation
ITEM
1-3. Self explanatory.
4.

Social Security No. - Enter the Social Security Number.

5-8. Self explanatory.
9.

Allotment.

9a. Emphasize the statement: “I understand that my contribution
for the allottee shall be deducted from my living allowance.”
9b. Self explanatory.
9c. Enter the complete name and address (two letter code for State)
of the person to whom the applicant wishes to make an
allotment.

List the relationship of that person to the applicant.
An allotment may not be apportioned between two or more allottees.
Allotment cannot be paid to children.
Residents of foreign countries are not eligible to receive an allotment.
An allotment must go to the person or agency caring for the child.
The applicant may contribute $5, $10, or $15 from the biweekly pay.
However, the $15 contribution cannot be made until the applicant’s biweekly
pay is at least $30. Job Corps will match the applicant’s contribution by a
multiple of 5. For example, a $10 applicant contribution will be matched by
a $50 Job Corps contribution.
10. After typing the name of the Admissions Counselor or Representative, the
Admissions Counselor will sign. The signature means that the Admissions
Counselor has obtained documentation to verify the applicant’s eligibility to
make an allotment to the allottee named in 9c, has annotated the type of
documentation obtained in the agency’s files, and is authorizing the
government to initiate an allotment for the allottee.
Part II - Appeal of Allotment Disallowance
If original determination for allotment was not allowed, and
If a review with the applicant indicates that the applicant has adequate grounds
for an appeal, and
If the Center Director or authorized delegate agrees with the review,
Then an authorized official signs it, enters date in item 2 and sends it to the
admissions agency listed in item 2 of Part 1.
Part III - Appeal Determination
Have admissions counselor review information in Part 11.
Complete items 1 through 6 and return form to Center.