Supplemental Youth Services Program Report (Tribal Govermment Grantees)

Reporting and Performance Standards for WIA Indian and Native American Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0422 can be found here:

Documents and Forms

Document Name Document Type
INA-SPIR-Specifications- may 2013.doc Instruction
ETA 9084 General Reporting Instructions for the Comprehensive Ser ETA 9084 General Reporting Instructions September 5 20131final.doc Form and Instruction
ETA 9084 General Reporting Instructions September 5 20131.doc ETA 9084 Services Program Report Added Fields Yellow Highlighted IC Document

Information Collection (IC) Details

IC Title:	Supplemental Youth Services Program Report (Tribal Govermment Grantees)	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 652

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction			INA-SPIR-Specifications- may 2013.doc		Yes	Yes	Fillable Fileable
Form and Instruction	ETA 9084	General Reporting Instructions for the Comprehensive Services Program Report and Standardized Participant Information Record Data	ETA 9084 General Reporting Instructions September 5 20131final.doc		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/ETA-15	FR Citation: 67 FR 16898

Number of Respondents: 81	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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	324	-6,483	-166	6,973
Annual IC Time Burden (Hours)	7,776	-20,194	-682	28,652
Annual IC Cost Burden (Dollars)	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 9084 Services Program Report Added Fields Yellow Highlighted	ETA 9084 General Reporting Instructions September 5 20131.doc	09/17/2013

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