Attachment I (Accessible PDF).pdf

ETA Advisory File Text

OMB Control Number 1205-0275 Expiration Date 09 30 2025 U.S. Department of Labor Employment and Training Administration Office of Trade Adjustment Assistance Trade Adjustment Assistance TAA for Workers Funding Request Form 1. STATE 2. AMOUNT REQUESTED 3. FINANCIAL DATA Complete for each relevant fiscal year allocation Fiscal Year Period Covered by this Report MM DD YYYY From To 1 Administrative Costs 2 Employment and Case Management 3 Training and Related Costs 4 Program Total 2 3 5 Grand Total 1 4 A. TAA Funds Received to Date B. Cumulative Obligations C. Unobligated Balance A-B D. Cumulative Accrued Expenditures E. Utilization Percentages D1 A5 D2 A5 Fiscal Year Period Covered by this Report MM DD YYYY From To 1 Administrative Costs 2 Employment and Case Management 3 Training and Related Costs 4 Program Total 2 3 5 Grand Total 1 4 A. TAA Funds Received to Date B. Cumulative Obligations C. Unobligated Balance A-B D. Cumulative Accrued Expenditures E. Utilization Percentages D1 A5 D2 A5 Fiscal Year Period Covered by this Report MM DD YYYY From To 1 Administrative Costs 2 Employment and Case Management 3 Training and Related Costs 4 Program Total 2 3 5 Grand Total 1 4 A. TAA Funds Received to Date B. Cumulative Obligations C. Unobligated Balance A-B D. Cumulative Accrued Expenditures E. Utilization Percentages D1 A5 D2 A5 Page 1 of 2 For more information visit our website at https www.doleta.gov tradeact ETA-9117 Revision Date 7 2019 OMB Control Number 1205-0275 Expiration Date 09 30 2025 U.S. Department of Labor Employment and Training Administration Office of Trade Adjustment Assistance Trade Adjustment Assistance TAA for Workers Funding Request Form 4. JUSTIFICATION FOR REQUEST Certification I certify that to the best of my knowledge and belief that the information provided herein is accurate and complete and that report obligations are reflected in agency records. Signature Title Date Persons are not required to respond to this collection of information unless it displays a currently valid Office of Management and Budget OMB control number. Public reporting burden for this collection is estimated to average 2 hours per response including the time for reviewing instructions searching existing data sources gathering and maintaining the data needed and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to U.S. Department of Labor Employment and Training Administration Office of Trade Adjustment Assistance Room N-5428 200 Constitution Avenue N.W. Washington DC 20210 OMB Control No. 1205- 0275 . Page 2 of 2 For more information visit our website at https www.doleta.gov tradeact ETA-9117 Revision Date 7 2019