Job Corps Health Questionnaire

ICR 201306-1205-001

OMB: 1205-0033

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supporting Statement A
2014-01-23
Supplementary Document
2010-11-18
Supplementary Document
2010-11-17
Supplementary Document
2010-11-17
IC Document Collections
IC ID
Document
Title
Status
12954 Modified
ICR Details
1205-0033 201306-1205-001
Historical Active 201010-1205-010
DOL/ETA
Job Corps Health Questionnaire
Revision of a currently approved collection   No
Regular
Approved without change 03/25/2014
Retrieve Notice of Action (NOA) 01/28/2014
  Inventory as of this Action Requested Previously Approved
03/31/2017 36 Months From Approved 03/31/2014
87,581 0 92,591
7,298 0 7,716
0 0 0

Information on the health status of an applicant to Job Corps is obtained when the applicant completes ETA 653 during an interview with the admissions counselor as part of the admissions process.

PL: Pub.L. 105 - 220 Title 1C Name of Law: The Workforce Investment Act of 1998
  
None

Not associated with rulemaking

  78 FR 42803 07/17/2013
79 FR 4494 01/28/2014
Yes

1
IC Title Form No. Form Name
Job Corps Health Questionnaire ETA 653 Health Questionnaire

  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 87,581 92,591 0 0 -5,010 0
Annual Time Burden (Hours) 7,298 7,716 0 0 -418 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Fewer applicants filled out the questionnaire over the last three years since the previous extension request in 2010.

$198,733
No
No
No
No
No
Uncollected
Bonnie Naradzay 202-693-3675 Naradzay.Bonnie@dol.gov

  No

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
 
 
 
 
 
 
 
    (i) Why the information is being collected;
    (ii) Use of information;
    (iii) Burden estimate;
    (iv) Nature of response (voluntary, required for a benefit, or mandatory);
    (v) Nature and extent of confidentiality; and
    (vi) Need to display currently valid OMB control number;
 
 
 
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
01/28/2014


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