Job Corps Health Questionnaire

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0033 can be found here:

Documents and Forms

Document Name Document Type
Form ETA-653 Job Corps Health Questionnaire Form and Instruction
ETA-653 Job Corps Health Questionnaire ETA-653 (OMB 1205-0033) highlighted.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Job Corps Health Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 20 CFR 670.410

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA-653	Job Corps Health Questionnaire	ETA-653 (OMB 1205-0033) highlighted.pdf		Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/ETA-8	FR Citation: 67 FR 16816

Number of Respondents: 87,943	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	87,943	-14,890	102,833
Annual IC Time Burden (Hours)	7,329	-1,240	8,569
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.