GAL2-00Attach1.pdf

ETA Advisory File Text

Petition For Trade AdjustmentU.S. Department of Labor AssistanceEmployment and Training Administration This is a petition for Trade Adjustment Assistance under Section 221 a of the Trade Act of 1974 as amended. If the firm of which you are or were employed does not manufacture a product you cannot be certified for benefits and you should not file a petition. OMB No. 1205-0192 Expires 07 31 2003 I. State the name address and telephone number of each petitioner and identify the group of workers on whose behalf the petition is filed. Print or type. For each petitioner who is a worker and who is not currently employed at the firm give the date of his or her most recent total or partial separation from the firm. Name 1 2 3 Address Telephone Date of Separation Identify the group of workers involved in the separations If the petition is being filed by a worker representative give the capacity in which the petitioner is filing e.g. union local president corporate treasurer. II.List the complete name and address of the firm and each subdivision of the firm at which the workers for whom this petition is filed are were employed. III.State the name address telephone number and title of a company official who can be contacted for additional information. The official should be someone knowledgeable about the firm s production sales and employment. IV. State the date on which separations due to increased imports began and continued or are scheduled to begin and the approximate number of workers affected. List this information separately for each subdivision of the firm listed in Section II above. V. Give a description of the articles products produced by the firm the sales or production of which are being hurt by the increased imports and a description of the imported articles concerned. Include such information as the common and technical names of the articles the method manufactured the end uses and the wholesale or retail value of the articles. VI.State the reasons for believing increased imports of articles competitive with those described in Section V above have caused a decline in the sales or production of the firm or a subdivision of the firm and to the workers actual or threatened loss of employment. Attach any supporting documents such as statements by officials of the firm or newspaper articles. VII. Has this group of workers been previously certified Yes No Don t Know Before signing be sure that all seven sections of the form have been filled out. This petition must be signed by three workers of the firm or by their duly authorized representative.Date SignedI we hereby affirm that the information included in this petition is correct to the best of my our knowledge and belief. ETA 8560 Jan. 1989 Processing Instructions Petition for Adjustment Assistance 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 15 minutes per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collections of information. Send comments regarding this burden estimate or any other aspects of this collection of information including suggestions for reducing this burden to the U.S. Department of Labor Division of Trade Adjustment Assistance Room C-5311 200 Constitution Avenue N.W. Washington D.C. 20210 Paperwork Reduction Project 1205-0192 . Who may file a petition- A petition may be filed by a group of three or more workers in a firm or a subdivision thereof or by their union or other duly authorized representative. The workers on whose behalf a petition is filed must be or have been employed regularly at the firm or subdivision identified in the petition. The workers employment must be or have been related to the production of articles described in the petition. Assistance in preparing a petition- Workers may request assistance in preparing a petition at any local employment security agency office. Also workers may write or telephone 202-693-3560 the Division of Trade Adjustment Assistance. Filing a petition- Petitions should be addressed to U.S. Department of Labor Employment and Training Administration Division of Trade Adjustment Assistance 200 Constitution Ave. N.W. Room C-5311 Washington D.C. 20210 General Instructions- Print or type. Complete all items. If more space is needed attach additional sheets to this form. In some cases some of the information requested may not be available. If so give the reason it is not available e.g. the firm will not release the information. Submit a signed original and two clear copies of this form when filing a petition. Further information and clarification concerning the filing of this petition may be found in Title 29 of the Code of Federal Regulations Part 90. How this information will be used- The U.S. Department of Labor will use the information contained on the Form ETA 8560 to conduct an investigation to determine whether the group of workers included on the petition meets the certification criteria established by law for eligibility to apply for adjustment assistance.