Eta 8429 Form – Fill Out and Use This PDF

The ETA 8429 form is a document utilized by the U.S. Department of Labor to record complaints or referrals made within One Stop Career Centers (OSCC). This form facilitates the detailed documentation of grievances against employers or OSCC offices, ensuring a structured process for addressing and investigating complaints. To assist individuals in raising their concerns effectively, a structured and confidential process has been established, encouraging them to fill out the form accurately.

If you need to file a complaint or referral, ensure you provide all the necessary information for an effective investigation. Click the button below to start filling out your form.

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Eta 8429 Form PDF Details

The Eta 8429 form serves as a critical piece in the intricate puzzle of employment law, monitored and managed by the U.S. Department of Labor through its Employment and Training Administration. As a Complaint/Referral Record for One Stop Career Center (OSCC) Use Only, this document encapsulates the procedure for filing grievances related to the workplace, highlighting the nuanced facets of employment standards and the pursuit of justice within the labor market. The form meticulously gathers complainant and respondent details, the core of the complaint, and flags the complaint for specific types of violations, ranging from wage discrepancies to discrimination, hence mapping out a clear pathway for resolution or referral to appropriate enforcement agencies. With its mandate extending until December 31, 2018, the Eta 8429 form emphasizes the importance of accurate, truthful information submission while also safeguarding the confidentiality of the complainant to the fullest extent afforded by law. It underscores the collaborative effort between federal oversight and local execution to ensure fair working conditions, acting as a bridge for aggrieved parties to seek redress or guidance. This document not only outlines procedural adherence but also reflects the broader commitment of the U.S. labor department towards fostering a responsible, compliant, and equitable working environment.

Question	Answer
Form Name	Eta 8429 Form
Form Length	2 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	30 sec
Other names	complaint referral, complaint record, labor career complaint, eta 8429 complaint form

Form Preview Example

U.S. Department Labor	OMB Approval No. 1205-0039
Employment and Training Administration	Expiration Date: Dec. 31, 2018
Employment and Training Administration

One Stop Career Center (OSCC) Complaint/Referral Record

For OSCC Use Only

Complaint No.

Date Received


Part I. Complainant’s Information		Respondent’s Information
1. Name of Complainant (Last, First, Middle Initial)		4.	Name of Person Complaint Made Against

2a.	Permanent Address (No., St., City, State, ZIP Code)	5.	Name of Employer/OSCC Office

b.	Temporary Address (if Appropriate)	6.	Address of Employer/OSCC Office

3a. Permanent Telephone

(

)

b. Temporary Telephone

(

)

7. Telephone Number of Employer/OSCC Office

(

)

8.Description of Complaint (If additional space is needed, use separate sheet(s) of paper and attach to this form)

I CERTIFY that the information furnished is true and accurately stated to the best of my knowledge. I AUTHORIZE the disclosure of Certification this information to other enforcement agencies for the proper investigation of my complaint. I UNDERSTAND that my identity will

be kept confidential to the maximum extent possible, consistent with applicable law and a fair determination of my complaint.

9.Signature of Complainant

10.Date Signed

ETA 8429

Revised May 2012

Expiration Date: 12/31/2018

Part II. For OSCC Use Only

1. Migrant or Seasonal Farmworker?

3. If non-Job Service-related, does Complaint concern laws

5. H-2a/Criteria Employer

Yes

enforced by Wage and Hour Division (formerly called the

U.S./Domestic Worker

Employment Standards Administration) U.S. D.O.L.

2. Type of Complaint (“X” Appropriate

WHD or OSHA?

Yes

Box(es))

4. Kind of complaint (“X” Appropriate Box(es))

H-2a Worker

Job Service Related Job Order No.

Wage Related

Housing

Wages

Against Job Service

Child Labor

Pesticides

Transportation

Against Employer

Working Conditions

Health/Safety

Alleged Violation of WIA

Migrant and Seasonal

Disability

Agricultural Worker

Discrimination

Regulations

Meals

Alleged Violation of Employment

Protection Act (MSPA)

Housing

Law(s)

Discrimination*

Other

Non-Job Service Related

Other (Specify)

6.*For DISCRIMINATION COMPLAINTS ONLY. Persons wishing to file complaints of discrimination may file either with the State Workforce Agency, or with the Directorate of Civil Rights (DCR), U. S. Department of Labor, 200 Constitution Avenue, NW, Room N-4123, Washington, D.C. 20210.

7a. Referrals To Other Agencies (“X” one)

WHD. U.S. DOL. OSHA U.S. D.O.L. Other

b. Follow-Up (“X” one)		Monthly	c.		Follow-up Date
Yes	No	Quarterly		/	/

8.Address of Referral Agency (No., St., City, State, ZIP Code and Telephone No.)

( ) -

9. Comments (If additional space is needed, use separate sheet of paper) Provide OSCC Services?

Yes

No If “No”, explain.

Complaint resolved?				Yes		No If “No”, explain.
10a.	Name and Title of Person Receiving Complaint	11.	Office Address (No., St., City, State, ZIP Code)

b. Phone No.		12a.	Signature		b.	Date
( )	-				/	/

Public Burden Statement

Persons are not required to respond to this collection of information unless it displays a currently valid OMB Control Number. Obligation to reply is required to obtain or retain benefits (44 USC 5301). Public reporting burden for this collection is estimated to average 8 minutes per response, including the time to review instructions, search existing data sources, gather and maintain the data needed, and complete and review the collection of information. Send comments regarding this burden estimate or any other aspect of this collection, including suggestions for reducing this burden, to the U.S. Department of Labor, Employment and Training Administration, Office of Workforce Investment, Room C-4510, 200 Constitution Avenue, NW, Washington, DC 20210.