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⚠️ Notice: This information collection may be referencing outdated material.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 Health Questionnaire ETA 653 Form final 2013.docx Form and Instruction
ETA 653 Form Edits_August 2013.docx ETA 653 Health Questionnaire IC Document

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: Required to Obtain or Retain Benefits

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	Health Questionnaire	ETA 653 Form final 2013.docx		Yes	Yes	Fillable Fileable

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: 87,581	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	87,581	-5,010	92,591
Annual IC Time Burden (Hours)	7,298	-418	7,716
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
ETA 653 Health Questionnaire	ETA 653 Form Edits_August 2013.docx	11/04/2013

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