Job Corps Health Questionnaire

ICR 201703-1205-001

OMB: 1205-0033

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
12954 Modified
ICR Details
1205-0033 201703-1205-001
Historical Active 201306-1205-001
DOL/ETA
Job Corps Health Questionnaire
Revision of a currently approved collection   No
Regular
Approved with change 06/01/2017
Retrieve Notice of Action (NOA) 03/21/2017
  Inventory as of this Action Requested Previously Approved
06/30/2020 36 Months From Approved 05/31/2017
66,697 0 87,581
8,893 0 7,298
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.

US Code: 29 USC 3199 Name of Law: Workforce Innovation and Opportunity Act
  
None

Not associated with rulemaking

  81 FR 89151 12/09/2016
82 FR 14524 03/21/2017
No

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 66,697 87,581 0 0 -20,884 0
Annual Time Burden (Hours) 8,893 7,298 0 0 1,595 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
There were no program changes that would result in burden changes. However, the reduction in applicants accounted for reduced hours in #12. During PY 2016, 66,697 applicants completed applications for Job Corps. This number of applications is reduced from the PY2011 figure of 87,581 applicants in the previously approved ICR. While not expected to affect burdens, Form ETA 653 has been changed to clarify the instructions and several questions.

$459,432
No
No
No
No
No
Uncollected
Walter Parker 202 693-2778 parker.walter@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.
03/21/2017


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