Back to Federal guidance
2011 TAA and ATAA petition forms
Summary ETA directed states to make revised Trade Adjustment Assistance and Alternative TAA petition forms available from February 15, 2011 as program rules reverted to the 2002 amendments. Attached English and Spanish forms support a combined request. Change 1 later ended acceptance of older April 2009 forms after June 30, 2011.
Document
Federal guidance
Agency
U.S. Department of Labor, Employment and Training Administration (ETA)
Document number
TEGL No. 19-10
Date issued
February 14, 2011
Status
Withdrawn
ETA lists this advisory Canceled as of 2026-10-24; its signed letter prints Expiration Date: Continuing and Rescissions: None. Change 1 later made expired 2009 forms invalid from July 1, 2011.
Status last verified October 24, 2026
Is this still the rule?
This document has been withdrawn. Ezel checks what federal law requires today, under current federal labor law, and answers your situation with citations.
About this page: The full text below is the official document from U.S. Department of Labor, Employment and Training Administration (ETA). Ezel adds the plain-English summary and tracks the document's status. The official source linked on this page is authoritative for any reliance.
Accessible letter PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2011/TEGL19-10-ACC.pdf
CLASSIFICATION
TAA
EMPLOYMENT AND TRAINING ADMINISTRATION
ADVISORY SYSTEM CORRESPONDENCE SYMBOL
OTAA
U.S. DEPARTMENT OF LABOR
Washington, D.C. 20210 DATE
February 14, 2011
ADVISORY: TRAINING AND EMPLOYMENT GUIDANCE LETTER NO. 19-10
TO: STATE WORKFORCE LIAISONS
STATE WORKFORCE AGENCIES
ONE-STOP CENTER SYSTEM LEADS
STATE WORKFORCE ADMINISTRATORS
STATE AND LOCAL WORKFORCE BOARD CHAIRS AND
DIRECTORS
STATE LABOR COMMISSIONERS
FROM: JANE OATES /s/
Assistant Secretary
SUBJECT: Petition Forms to File for Trade Adjustment Assistance and
Alternative Trade Adjustment Assistance -- Starting February 15,
2011
1. Purpose. Training and Employment Guidance Letter (TEGL) No. 16-10,
Change 2, instructs the State Workforce Agencies or agencies designated by
Governors as "Cooperating State Agencies" (CSAs) (also jointly referred to as
"states") to operate the Trade Adjustment Assistance (TAA) program under the 2002
Amendments, starting February 15, 2011. This guidance requests that states provide
updated petition forms starting on that same date, February 15, 2011. Downloadable
(paper) and online petition forms that are currently in use will be rendered obsolete
as of that date because they do not allow petitioners to request Alternative Trade
Adjustment Assistance (ATAA).
2. References. The Omnibus Trade Act of 2010, Public Law, (P. L.) No. 111-344
(enacted December 29, 2010) (Omnibus Trade Act); The Trade and Globalization
Adjustment Assistance Act of 2009, Division B, Title I, Subtitle I of the American
Recovery and Reinvestment Act of 2009, P. L. No. 111-5 (enacted February 17,
2009) (TGAAA or 2009 Amendments); the Trade Adjustment Assistance Reform
Act of 2002, Division A, Title I, Subtitle A of the Trade Act of 2002 (P. L. 107-210)
(2002 Amendments); the Trade Act of 1974, as amended, P.L. No. 93-618, as
amended (Trade Act); 20 CFR Part 90; Training and Employment Guidance Letter
(TEGL) No. 22-08 and Change 1, Operating Instructions for Implementing the
Amendments to the Trade and Globalization Adjustment Assistance Act of 2009;
TEGL No. 16-10, Instructions for Phasing Out Changes to the Trade Act of 1974
Enacted by the Trade and Globalization Adjustment Assistance Act of 2009 and
TEGL No. 16-10 , Change 2, Instructions for Operating the Trade Adjustment
Assistance Program after the Termination of the Trade and Globalization Adjustment
Assistance Act Amendments on February 12, 2011- Program Reverts to 2002
Amendments; and OMB PRA Information Collection Control No. 1205-0342 (ETA-
9042), approval issued January 14, 2011.
RESCISSIONS EXPIRATION DATE
None Continuing
3. Background. The first step in obtaining TAA and ATAA benefits is to file a
petition on behalf of a worker group with the U.S. Department of Labor (Department),
Office of Trade Adjustment Assistance (OTAA) to request certification of group
eligibility to apply for benefits under the 2002 Amendments. The 2002 Amendments
require petitioners to specifically request ATAA at the time a petition for TAA is filed.
The TAA petition forms in effect under the 2009 Amendments are inadequate for this
purpose since they do not mention ATAA. Since the Department previously provided
notice that it will accept petitions received on or before February 14, 2011 and
investigate and make determinations on these petitions under the certification
requirements of the 2009 Amendments, petitions received starting February 15, 2011
will be governed by the 2002 Amendments and therefore require use of the revised
(updated) forms described below.
English and Spanish versions of this form, the “Petition for Trade Adjustment
Assistance (TAA) and Alternative Trade Adjustment Assistance (ATAA)”, may be
downloaded from the Department’s Employment and Training Administration website
at www.doleta.gov/tradeact. The online petition is also located on that website and has
been updated to enable petitioners to file online for TAA and ATAA benefits under the
2002 Amendments. These updated forms are identified by the same numbers as the
current forms; however, the Department will recognize the correct forms by the new
title, and the revision date (Rev. January 2011), which is found in the lower right-hand
corner of the form below the form number (ETA-9042, ETA-9042A or ETA-9042A-1).
4. Instructions. Effective February 15, 2011, states are instructed to begin using the
updated forms with revision dates identified below:
ETA-9042 (Rev. January 2011), Petition for Trade Adjustment Assistance
and Alternative Trade Adjustment Assistance
ETA-9042A (Rev. January 2011), Solicitud de Asistencia Para Ajuste del
Comercio y Asistencia Alternativa Para Ajuste del Comercio
ETA-9042A-1 (Rev. January 2011), Online Petition for Trade Adjustment
Assistance and Alternative Trade Adjustment Assistance, available online at
www.doleta.gov/tradeact.
CSA administrators are requested to distribute the approved forms to appropriate
CSA staff. States are requested to make revised ETA Forms 9042 (Rev. January
2011), 9042A (Rev. January 2011), and 9042A-1 (Rev. January 2011) available in
all local offices (including One-Stop operators, One-Stop partners, and state
workforce agencies) to individuals wishing to file a petition for TAA and ATAA on
and after February 15, 2011.
Current forms will be rendered obsolete starting February 15, 2011; therefore CSA
administrators are also requested to ensure that copies of the current petition forms,
ETA 9042 (Rev. 4/09) and ETA 9042A (Rev. 4/09), are not available to petitioners
after February 14, 2011. The current petition forms should be removed from local
offices and state websites.
2
In order to prevent petitioners from filing a petition using obsolete forms, CSAs
should encourage individuals wishing to file a petition for TAA and ATAA to the
online format, ETA-9042A-1 (Rev. January 2011), by accessing
http://www.doleta.gov/tradeact, and then by clicking on “File Online”.
5. Action Requested. Starting February 15, 2011, CSAs will be required to
manage benefits and services provided to TAA program participants as described in
TEGL 16-10, Change 2 and use the forms described above when they file petitions
on behalf of workers. States will be notified if the sunset provisions of the TGAAA
are extended to allow the 2009 Amendments to continue to apply after 11:59 PM
EST February 14, 2011. States also will be notified of procedures that will apply if
the incorrect petition forms are filed on or after February 15, 2011.
6. Paperwork Reduction Act. The Department is issuing this guidance to align
the ETA collection forms in OMB 1205-0342 (TAA Petition form), with the TAA
program under the 2002 amendments. The Department has submitted the necessary
change requirements to OMB and received the appropriate approvals in accordance
with the Paperwork Reduction Act of 1995.
7. Inquiries. State Administrators should direct all inquiries to the appropriate
ETA Regional Office.
8. Attachments.
A. ETA-9042 (Rev. January 2011), Petition for Trade Adjustment
Assistance and Alternative Trade Adjustment Assistance
B. ETA-9042A (Rev. January 2011), Solicitud de Asistencia Para Ajuste
del Comercio y Asistencia Alternativa Para Ajuste del Comercio
C. ETA-9042A-1 (Rev. January 2011), the Online Petition for Trade
Adjustment Assistance and Alternative Trade Adjustment Assistance can
be accessed at the following link:
https://www.etareports.doleta.gov/petition/index.cfm?reset=true.
3
Official attachment PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2011/636038-9-ATT-A.pdf
U.S. Department of Labor Employment and Training Administration OMB No. 1205-0342
Expires: 1/31/2013
Petition for Trade Adjustment Assistance (TAA) and
Alternative Trade Adjustment Assistance (ATAA)
About the Trade Adjustment Assistance (TAA) Program
The Trade Act of 1974 (19 USC § 2271 et seq.), as amended, established Trade Adjustment Assistance (TAA) to provide assistance to
workers in firms hurt by foreign trade. Program benefits include long-term training while receiving income support. TAA provides both
rapid and early assistance. Filing this petition is the first step in qualifying for benefits and assistance. After the petition is filed, the
U.S. Department of Labor will determine whether a significant number or proportion of the workers of the firm have become total or
partially separated or are threatened to become totally or partially separated, and whether imports or a shift in production to a foreign
country contributed importantly to these actual or threatened separations and to a decline in sales or in production of articles If a
petition is approved and the workers are certified as eligible to participate in the TAA program, workers covered by a certification may
contact their state workforce agency to apply for benefits. These benefits are provided at no expense to employers.
About the Alternative Trade Adjustment Assistance (ATAA) Program
Alternative Trade Adjustment Assistance (ATAA) for older workers is an alternative to TAA for trade affected workers 50 years of age or
older. ATAA encourages qualified trade affected workers to quickly obtain full-time employment by providing a wage subsidy in lieu of
training and income support. Submission of a completed Petition Form signifies a desire to file for both TAA and ATAA. If certified for
both programs, workers will have the option of applying for TAA benefits and services and, if reemployment occurs within 26 weeks of
the worker’s separation, may be eligible to receive ATAA instead of TAA, if the worker desires.
Filing Instructions
A group of three workers from the same firm at the same job location, a union official, a state or local workforce agency
representative in a local One Stop Career Center, an employer official, or a legally authorized representative must complete this
Petition Form by answering all questions before submitting to the U.S. Department of Labor.
You must date and submit the Petition Form within 1 YEAR from the date on which the workers were separated or had their hours
or wages reduced.
You must file the Petition Form with both the U.S. Department of Labor in Washington, DC and the TAA Coordinator or the
dislocated worker office of the state where the firm is located.
To file with the U.S. Department of Labor, use one of the methods below:
Fax the completed Petition Form to 202-693-3585, OR
Mail the completed Petition Form to the U.S. Department of Labor at:
U.S. Department of Labor
Office of Trade Adjustment Assistance
200 Constitution Ave NW, Room N-5428
Washington, DC 20210
To file with the TAA Coordinator or the dislocated worker office of the state:
Use the contact information below to find the appropriate filing address. If this Petition Form includes firms in different states,
copies of this completed Petition Form must be filed in each state where firms are located.
Toll-Free Helpline: 1-877-US2-JOBS (TTY) 1-877-889-5627
Internet: http://www.doleta.gov/tradeact/contacts.cfm#State, or
http://www.servicelocator.org
For assistance in preparing a petition
Petitioners may request assistance in preparing the petition at their local One-Stop Career Center, by contacting the U.S. Department
of Labor in Washington, D.C. at 202-693-3560 (Main Number), or by contacting their State Dislocated Worker Unit or State Workforce
Agency through the telephone numbers or internet addresses provided above.
To check the status of your petition, go to:
http://www.doleta.gov/tradeact/
Public Burden Statement
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. Responding is required to obtain or maintain benefits (19 USC 2321). Public reporting burden for this
collection is estimated to average 20 minutes per response, including the time for reviewing instructions, searching existing data
sources, gathering and maintaining the data needed, completing and reviewing the collection of information, and a state review. Send
comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this
burden, to the Department of Labor at the address provided above (Paperwork Reduction Project 1205-0342).
Page 1 of 3 For more information, visit our Web site at http://www.doleta.gov/tradeact ETA-9042
Rev. January 2011
Previous forms not usable
U.S. Department of Labor Employment and Training Administration OMB No. 1205-0342
Expires: 1/31/2013
Petition for Trade Adjustment Assistance (TAA) and
Alternative Trade Adjustment Assistance (ATAA)
Section 1. Petitioner Information
Provide petitioner information below. Three workers from the same job location completing this Petition Form must fill in
all three columns. Other petitioners need only fill in the Petitioner 1 column. A union official completing this petition form
should provide the name of the Union.
Petitioner 1 Petitioner 2 Petitioner 3
a) Name
b) Title
c) Street Address
City
State, Zip
d) Phone – Main
e) Phone – Alternate
f) E-mail
g) Worker Separation Date
h) Petitioner Type: Three Workers Company Official Union Official (Union Name_______)
(please check one) State Workforce Office One-Stop Operator/Partner Other Authorized Representative
i) Describe the worker group on whose behalf this petition is being filed:
Section 2. Workers’ Firm
Provide information on the firm employing the worker group. Complete items (a) – (g) regarding the employing firm. If the workers are
doing work at a location that is different than the worker’s employer (e.g., the petitioning workers are employed by a staffing agency but
work at a manufacturing firm), also complete items (h) – (m) regarding the firm at which the workers perform their jobs.
NOTE: Workers completing this Petition Form must provide information for the location where they work. All other petitioner types may
apply on behalf of more than one location. State offices and One-Stop Operators/Partners may file for workers at multiple locations of a
firm within their State. If you choose to file on behalf of workers at more than one location, please attach additional sheets as
necessary.
Employer (Firm)
a) Name of Firm
b) Street Address
City
State, Zip
c) Phone
d) Website (if known)
e) Describe the article produced by this firm
f) How many workers have been or may be separated (if known)?
g) Is the firm or any part of the firm closing (if known)? If yes, when?
If the workers work at a location that is different from that listed in item a) and b), then fill out items h) through m) for that location:
h) Name of Firm
i) Street Address
City
State, Zip
j) Phone
k) Describe the article produced by this firm
l) How many workers have been or may be separated (if known)?
m) Is the firm or any part of the firm closing (if known)? If yes, when?
Page 2 of 3 For more information, visit our Web site at http://www.doleta.gov/tradeact ETA-9042
Rev. January 2011
Previous forms not usable
U.S. Department of Labor Employment and Training Administration OMB No. 1205-0342
Expires: 1/31/2013
Petition for Trade Adjustment Assistance (TAA) and
Alternative Trade Adjustment Assistance (ATAA)
Section 3. Trade Effects on Separations
1. To the best of your knowledge, provide reasons why you believe that separations that have occurred or may be threatened at the
workers’ firm are due to foreign trade. (Example: Production has been/is being shifted to a foreign country, increased imports of
articles, loss of business with a TAA-certified firm.)
2. If you possess any additional information or documents that you believe may assist in the determination of whether the worker group
is eligible for TAA benefits, submit it as an attachment to the Petition Form. Check the box below if you have attached any additional
information or supporting documents.
I have attached additional information or supporting documents.
3. Provide contact information for two company officials. Either separately or together, these officials should be familiar with all of the
following: employment, job functions, and sales or production at each job location.
Official 1 Official 2
a) Name
b) Title
c) Phone – Main
d) Phone – Alternate
e) Fax
f) E-mail
Section 4. Affirmation of Information
The information you provide on this petition form will be used for the purposes of determining worker group eligibility and providing
notice to petitioners, workers, and the general public that the petition has been filed and whether the worker group is eligible.
Knowingly falsifying any information on this Petition Form is a Federal offense (18 USC § 1001) and a violation of the Trade Act (19
USC § 2316). For this petition to be valid, each of the petitioners listed in Question 1 must sign below and the Petition Form must be
dated. By signing below, you agree to the following statements:
“I declare that to the best of my knowledge and belief the information I have provided is true, correct, and complete.”
a) Signature
b) Name (Print)
c) Date of Petition
Page 3 of 3 For more information, visit our Web site at http://www.doleta.gov/tradeact ETA-9042
Rev. January 2011
Previous forms not usable
Official attachment PDF: https://www.dol.gov/sites/dolgov/files/ETA/advisories/TEGL/2011/636038-9-ATT-B.pdf
Departamento del Trabajo Administración de Empleo y Adiestramiento OMB No. 1205-0342
Expiración: 1/31/2013
Solicitud de Asistencia para Ajuste del Comercio (TAA) y
Asistencia Alternativa para Ajuste del Comercio (ATAA)
Sobre el Programa de Asistencia para Ajuste del Comercio (TAA)
La Ley de Comercio de 1974 (19 USC § 2271), según enmendada, estableció el Programa de Asistencia para Ajuste del Comercio
(TAA – Trade Adjustment Assistance Program) para proveer servicios a los trabajadores empleados por firmas impactadas por el
comercio internacional. Los beneficios del programa incluyen adiestramiento a largo-plazo y ayuda financiera. TAA provee asistencia
rápida y temprana. El presentar esta solicitud es el primer paso hacia calificar para los beneficios y la asistencia. Después de recibir
la solicitud, el Departamento de Trabajo de los EE.UU. determinará si un número o proporción significativa de los trabajadores de la
firma ha sido totalmente o parcialmente cesanteada o si está amenazada con ser totalmente o parcialmente cesanteada, y si las
importaciones o la reubicación de la producción a un país extranjero contribuyó de manera importante a dichas cesantías y a una
disminución de las ventas o producción de artículosSi una solicitud es aprobada y los trabajadores son certificados como elegibles
para participar en el programa TAA, los trabajadores cubiertos por una certificación pueden contactar a la agencia estatal de empleo
(state workforce office) para solicitar los beneficios. Estos beneficios son proveídos sin costos para los patronos.
Sobre el Programa de Asistencia Alternativa para Ajuste del Comercio (ATAA)
El Programa de Asistencia Alternativa para Ajuste del Comercio (ATAA – Alternative Trade Adjustment Assistance) para trabajadores
mayores es una alternativa a TAA para trabajadores afectados que tienen 50 años o más. El programa ATAA alienta a los
trabajadores que certifica a conseguir rápidamente un empleo a tiempo completo mediante un subsidio salarial en lugar de
adiestramiento y asistencia económica. El someter una solicitud completa implica un deseo de obtener ambos TAA y ATAA. Si se
certifican para ambos programas, los trabajadores tendrán la opción de solicitar TAA y sus servicios, y, si obtienen un empleo dentro
de las 26 semanas luego del despido, pueden ser elegibles para recibir ATAA en vez de TAA, como decida el trabajador.
Instrucciones de la Solicitud
Un grupo de tres trabajadores de la misma firma en la misma ubicación de trabajo, o un funcionario de sindicato, o un
representante de una agencia local o estatal en un Centro de Trabajo One-Stop, o un funcionario empresarial, u otro
representante legalmente autorizado debe completar este Formulario de Solicitud, contestando todas las preguntas antes de
presentarlo al Departamento del Trabajo de los EE.UU.
Usted debe fechar y entregar el formulario de la solicitud en el plazo de UN (1) AÑO a partir de la fecha en la cual los trabajadores
fueron despedidos o sufrieron una reducción en el número de sus horas de trabajo o de salario.
Las solicitudes deben ser enviadas dos lugares: al Departamento de Trabajo en Washington D.C. y también al coordinador estatal
de TAA o la unidad de trabajadores desplazados en el estado donde se encuentra la firma.
Para radicar vía el Departamento del Trabajo, utilice uno de los métodos descritos en esta sección:
Envíe Telefax el Formulario de Solicitud al 202-693-3584 o 202-693-3585, o
Envíe por correo el Formulario de Solicitud al Departamento del Trabajo a la dirección:
U.S. Department of Labor
Office of Trade Adjustment Assistance
200 Constitution Ave NW, Room N-5428
Washington, DC 20210
Para radicar a un coordinador de TAA o a la oficina del Estado para los trabajadores afectados:
Utilice la información provista abajo para encontrar la dirección adecuada Si la solicitud incluye firmas o filiales de la firma en
diversos Estados, copias de la solicitud completa deben ser entregadas en cada Estado donde están localizadas las firmas.
Toll-Free Helpline: 1-877-US2-JOBS (TTY) 1-877-889-5627
Internet: http://www.doleta.gov/tradeact/contacts.cfm#State, or
http://www.servicelocator.org
Para asistencia en completar una solicitud
Los solicitantes pueden pedir asistencia en la preparación del Formulario de Solicitud en el Centro de Trabajo One-Stop local,
contactando el Departamento del Trabajo de los EE.UU. en Washington, D.C. al 202-693-3560 (Línea General), o contactando la
oficina del Estado para los trabajadores desplazados o Agencias Estates de Trabajo por medio de los números telefónicos o
direcciones de Internet que se encuentran arriba.
Declaración de Imposición Pública
Las personas no son requeridas a responder a esta recopilación de información a menos que muestre un número de control válido de
la Oficina de Gerencia y Presupuesto (Office of Management and Budget-OMB). Responder a este Formulario de Solicitud es un
requisito para obtener o mantener los beneficios (19 USC 2321). Se estima que la recopilación de información para la completar este
Formulario son 20 minutos en promedio por respuesta, incluyendo el tiempo para revisar las instrucciones, buscar las fuentes de datos
existentes, copilar y mantener los datos necesarios, y completar y revisar la colección de información. Envíe comentarios con respecto
al estimado de esta carga o cualquier otro aspecto de esta compilación de información, incluyendo sugerencias para reducir esta
carga, al Departamento del Trabajo a la dirección que se encuentra arriba (Paperwork Reduction Project 1205-0342).
Page 1 of 3 For more information, visit our Web site at http://www.doleta.gov/tradeact ETA-9042A
Rev. January 2011
Previous forms not usable
Departamento del Trabajo Administración de Empleo y Adiestramiento OMB No. 1205-0342
Expiración: 1/31/2013
Solicitud de Asistencia para Ajuste del Comercio (TAA) y
Asistencia Alternativa para Ajuste del Comercio (ATAA)
Sección 1. Información del Solicitante
Provea información del solicitante en esta sección. Tres trabajadores en la misma ubicación de trabajo deben llenar y completar este
Formulario en las tres columnas. Otros solicitantes deben completar solamente la columna del Solicitante 1. Un funcionario del sindicato que
completa este Formulario de Solicitud debe proveer el nombre del Sindicato.
Solicitante 1 Solicitante 2 Solicitante 3
a) Nombre
b) Título
c) Dirección
Ciudad
Estado, Código Postal
d) Teléfono – Principal
e) Teléfono – Secundario
f) Correo electrónico, email
g) Fecha de Cesantía:
h) Categoría de Solicitante: Tres Trabajadores Oficial de la Compañía Oficial del Sindicato
(seleccione uno) Oficina “State Workforce” Socio del One-Stop local Otro Representante Autorizado
i) Describa el grupo de trabajadores en cuyo nombre esta solicitud está siendo presentada:
Sección 2. Información de la Compañia
Provea información de la firma que emplea al grupo de trabajadores. Complete los detalles (a)-(h) con respecto a la firma empleadora. Si los
trabajadores trabajan en una ubicación diferente a la de su patronos (por ejemplo, si los trabajadores están contratados por medio de una
agencia de empleo pero trabajan en una firma de manufactura), también complete los detalles (i)-(m) con respecto a la firma en la cual los
trabajadores realizan sus labores.
NOTA: Los trabajadores completando este Formulario de Solicitud deben proveer información de la ubicación donde trabajan. Todas las otras
categorías de solicitantes pueden presentar esta solicitud a nombre de más de una ubicación. Oficinas estatales y socios del One-Stop local
pueden presentar la solicitud para trabajadores en varias ubicaciones de una firma dentro de su Estado. Si decide presentar la solicitud en
nombre de trabajadores en más de una ubicación, favor anexar copias de esta parte del Formulario de Solicitud, tal como sea necesario.
Firma Empleadora
a) Nombre de la Firma
b) Dirección (localización)
Ciudad
Estado, Código Postal
c) Teléfono
d) Página en la red de Internet (si conocida)
e) Describa el artículo producido por esta firma
f) ¿Cuantos trabajadores han sido o podrán ser cesanteados (si se sabe)?
g) ¿Estará cerrando la firma o alguna parte de la firma (si se sabe)? Si afirmativo, ¿cuándo?
Si los trabajadores trabajan en una ubicación diferente de aquella mencionada en detalles a) y b), favor completar detalles h) al m) para esa
ubicación:
h) Nombre de la Firma
i) Dirección (localización)
Ciudad
Estado, Código Postal
j) Teléfono
k) Describa el artículo producido por esta firma
l) ¿Cuantos trabajadores han sido o podrán ser cesanteados (si se sabe)?
m) ¿Estará cerrando la firma o alguna parte de la firma (si se sabe)? Si afirmativo, ¿cuándo?
Page 2 of 3 For more information, visit our Web site at http://www.doleta.gov/tradeact ETA-9042A
Rev. January 2011
Previous forms not usable
Departamento del Trabajo Administración de Empleo y Adiestramiento OMB No. 1205-0342
Expiración: 1/31/2013
Solicitud de Asistencia para Ajuste del Comercio (TAA) y
Asistencia Alternativa para Ajuste del Comercio (ATAA)
Sección 3. Efectos Comerciales en las Separaciones
1. Hasta donde tiene conocimiento, provee razones por las cuales usted cree que las cesantías que han sucedido o podrían suceder
en la firma de los trabajadores son debidos al comercio internacional. (Por ejemplo: La producción ha sido/está siendo reubicada a un
país extranjero, un aumento de importaciones de artículos, una pérdida de negocios con una firma certificada para TAA).
2. Si usted posee cualquier información adicional o documentos que usted cree podría asistir en la determinación sobre si el grupo es
elegible para los beneficios de TAA, favor presentarlos como anexo al Formulario de Solicitud. Marque el encasillado abajo si usted ha
incluido documentos que apoyan esta solicitud.
He incluido información adicional o documentación que apoya esta solicitud.
3. Provea información de dos oficiales empresariales. Juntos o separadamente, estos oficiales deberían estar informados con todos
los siguientes aspectos: empleo, funciones laborales, y ventas o producción en cada una de las ubicaciones de trabajo. de los
aspectos comerciales en cada firma/filial de la firma.
Oficial 1 Oficial 2
a) Nombre
b) Título
c) Teléfono- Principal
d) Teléfono- Secundario
e) Teléfax
f) Correo electrónico
Sección 4. Afirmación de la Información
La información que usted provea en esta solicitud será utilizada para determinar la elegibilidad del grupo de trabajadores y para avisar
a los solicitantes, a los trabajadores, y al público en general que se ha radicado la solicitud y sobre si el grupo del trabajador es
elegible. La falsificación con conocimiento de cualquier información en esta solicitud es una ofensa federal (18 USC § 1001) y una
violación de la Ley de Comercio (19 USC § 2316). Para que esta solicitud sea válida, cada solicitante listado en la pregunta 1 debe
firmar abajo y la solicitud debe ser fechada. Al firmar, está(n) de acuerdo con la siguiente declaración:
"Bajo penalidad legal, declaro que hasta donde tengo conocimiento, la información que he provisto es cierta, correcta, y
completa."
a) Firma del solicitante
b) Nombre (letra de molde)
c) Fecha de la Solicitud
Page 3 of 3 For more information, visit our Web site at http://www.doleta.gov/tradeact ETA-9042A
Rev. January 2011
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