SETAAC PETITION PROCESS
Thank you for your interest in applying for Trade Adjustment Assistance for Firms.
This document will detail the process and help collect the information required to submit a petition on
behalf of your firm.
Please complete all items on the forms. Each piece of information is REQUIRED and petitions will be
delayed until all items are completed. If an item is not applicable, please indicate with “N/A”.
The information required for the petition is time sensitive. The petition requires 24 months of recent
sales and employment data. If it takes more than 30 days to collect the information, updated sales and
employment information will be required.
There are 6 topic areas required to put together a complete SETAAC petition:
1. About Your Company: General company information. (This Word document)
2. About Your Product: General product & market information. (This Word document)
3. About Your Customers: Information about customers that represent a decline due to
import competition. (This Word document)
4. Supporting Documentation:
a. Most recent 24 months of financial statements.
b. Federal tax returns for the past two years (only the first 5-10 pages, no schedules,
etc.)
c. Most recent 24 months (8 quarters) of STATE employer quarterly reports.
Payroll reports will be required for months in which an employer quarterly
report has not yet been filed. Employment reports from third party employment
firms (i.e. ADP) are acceptable. Please note that part-time, seasonal, and
contract labor are all considered in the employee count.
CONFIDENTIALITY STATEMENT: The information provided in this document will be used only by the SETAAC staff at Georgia Tech to
complete the firm’s petition for the Trade Adjustment Assistance Program
PART 1: ABOUT YOUR COMPANY
 Company
County
Address
Phone
City
State
Congressional District
DUNS #
Contact Person
E-Mail
ZIP
 Form of Organization (check one)
Single Proprietorship
Partnership
Corporation
Other
LLC
 Related Firms – Please check all that apply, check N/A if not applicable
Successor Firm
Subsidiary
Affiliate
Foreign
Domestic
N/A
Subsidiaries and Affiliates – Please complete the following information for each affiliate or subsidiary. (Attach
a separate sheet if necessary)
Subsidiary/Affiliate Name
Address
City
Type of business
State
_
Nature of Intercompany Transactions
__________________________________________
Type of Relationship
_____________________________________________
Common Ownership Explanation
_____________________________________________
 Year founded
 Number of facilities
 Please list the location for each facility
___________________________________________________
________________________________________________________________________________________
 Names and titles of officers and directors
CONFIDENTIALITY STATEMENT: The information provided in this document will be used only by the SETAAC staff at Georgia Tech to
complete the firm’s petition for the Trade Adjustment Assistance Program
 Major ownership interests in the firm and their proportionate shares of ownership (Percent)
%
%
%
%
%
%
 Management and Supervisory Employees
Number of management and supervisory employees that are not considered production workers.
 Explain any significant management changes and ownerships changes that have occurred within the
past 5 years
______
_____________________________________________________________________________________
_____________________________________________________________________________________
 List other important events in the recent history of the firm, such as natural disasters, fires, labor strikes,
change in product mix, etc.
______
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
PART 2:
ABOUT YOUR PRODUCT
Describe the articles produced by the firm that have been affected by import competition.
 SIC or NAICS code
If unknown; reference: http://bit.ly/NAICS
 Description of goods produced and sold:
________________________________ _______
________________________________________________________________ ______________
Principal material used
 Description of goods produced and sold
________________________________
_____________________________________________________________________________
Principal material used
 Please list markets served (i.e. industrial, retail, military, electrical, furniture, etc.)
_________________________________________________________________________
 Do you serve domestic or international markets?
 If you export, what percent of sales
%
CONFIDENTIALITY STATEMENT: The information provided in this document will be used only by the SETAAC staff at Georgia Tech to
complete the firm’s petition for the Trade Adjustment Assistance Program
If applicable, describe any other articles produced by the firm that have not been affected by import
competition.


If applicable, describe any finished articles purchased for resale and indicate whether the purchased goods
are imported or domestic. Please do not include items that are used in your finished product.
 Description of goods purchased for resale:
________________________________
___________________________________________________________________________ __
Are purchases imported or domestic?
__________
If imported, which country?
__________
Period Beginning
and Ending
$ Amt of Resale items
Period Beginning
and Ending
$ Amt of Resale items
PART 3:
ABOUT YOUR CUSTOMERS
 As part of the petition process, we will contact at least two of the customers for verification of declines
in purchases; you will be contacted to determine which customers you prefer for us to contact.
Incomplete applications will be returned. This information should be for the same reporting periods as
sales and employment information that is requested in the Excel file. Please list four customers who
represent a significant level of decline due to imports.
Customer Name
Complete Address
Contact Name
Phone
Sales
From:
Through
$
Sales
From:
Through
$
Customer Name
Complete Address
Contact Name
Phone
Sales
From:
Through
$
Sales
From:
Through
$
CONFIDENTIALITY STATEMENT: The information provided in this document will be used only by the SETAAC staff at Georgia Tech to
complete the firm’s petition for the Trade Adjustment Assistance Program
Customer Name
Complete Address
Contact Name
Phone
Sales
From:
Through
$
Sales
From:
Through
$
Customer Name
Complete Address
Contact Name
Phone
Sales
From:
Through
$
Sales
From:
Through
$
Part 4: SUPPORTING DOCUMENTATION
Please collect and prepare to submit the following required supporting documentation:
 Financial Documents
Monthly or consolidated financial statements (Income Statement & Balance Sheet) for the entire 24month petition period.
 Tax Documents
Federal income tax returns for the most recent two years; please only send the first 5-10 pages, no
schedules, etc.). These are kept on file in the SETAAC office for auditing purposes only and never
accompany your petition to Washington D.C.
 State Employment Data Reports
Quarterly withholding forms sent to the State which tells how many people you have employed on a
monthly basis. We need copies of at least 8 quarters of the State quarterly reports that you file. Please
note that temporary employees and contractors that work on the import-impacted product can be
included in the employment figures; however, documentation for such workers should be provided.
Employment reports from third party employment firms (i.e. ADP) are acceptable.
 Inter-company Financial Transactions (If Applicable)
This information will reflect any inter-company transactions that show up on your financial statements
such as loans, a lease of facilities and equipment, and administrative services.
CONFIDENTIALITY STATEMENT: The information provided in this document will be used only by the SETAAC staff at Georgia Tech to
complete the firm’s petition for the Trade Adjustment Assistance Program