Information Collection

Job Corps Health Questionnaire

IC 12954 under ICR 201010-1205-010 · OMB 1205-0033.

⚠️ Notice: This information collection may be referencing outdated material.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 Applicant Health Questionnaire 653 updated Form_rev.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 Applicant Health Questionnaire	653 updated Form_rev.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: 92,591	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	92,591	4,648	87,943
Annual IC Time Burden (Hours)	7,716	387	7,329
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.