G. Instructions for Completion of Complaint Form-ETA Form 8429.pdf

Instructions for Completion of the Complaint Referral Record (ETA Form 8429)

“For One Stop Career Center (OSCC) Use Only” section (at top of form)

The Career Center Manager, or his/her designee, is required to complete this section. This information should correspond to the information entered on the quarterly log.

Part I (Complainant’s Information)

  1. Lines 1 thru 7 This section shall be filled out either by the complainant, his/her representative, or by the staff person receiving the complaint.
  2. Line 8 (Description of Complaint) Description of Complaint or Apparent Violation (If additional space is needed, use separate sheet(s) of paper and attach to this form, indicating the expected results.) If the complainant is unable to fill out this section and assistance is given, the statement should be written in the first person. Additional sheets are to be identified with the name and signature of the complainant. To ensure that no further comments are added to the original statement, a diagonal line shall be drawn from the last word of the statement to the end of the page.
  3. Line 9 and 10 (Signature of Complainant and Date) The form must be signed by at least one complainant (If more than one, list all names) for the complaint to be referred to a higher level. If the complainant refuses to do so, a statement by the Career Center official taking the complaint will be written to this effect. The complainant will be further advised, in writing by the Career Center Manager, that since he/she refuses to sign the complaint, no further action can be taken on the complaint. The complainant’s signature must be on each additional sheet used for line 8 (Description of Complaint).

Part II (For OSCC Use Only)

  1. The Career Center Manager, or his/her designee, is required to complete lines 6a through 12e. This information should correspond to the information entered on the quarterly log.
  2. Make four copies of completed and signed form:
    • Original and one copy shall be kept in the local Career Center complaint file.
    • One copy shall be given to the complainant.
    • One copy shall be sent to the State Complaint Resolution Administrator or other referred agency with copies of all other documents related to that claim.

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