OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

COVID-19 Symptom Tracker for Students, Emotional Wellness Form for Students, and Student Vaccination Status and Test Consent Form Collection

ICR 202207-1205-003 · OMB 1205-0548 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form ETA 9197 Student Vaccination Certification and Testing Consent Form Modified Available
Form 9197 071222 tracked.docx Supplementary Document Uploaded 2022-07-18 Available
Program Instruction Notice 21-12 Aligning with CDC IHE.pdf Supplementary Document Uploaded 2022-07-18 Repair queued
Justification for Non-Material Change 071822.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-07-18 Available
PIN 21-04 Resumption of Traditional Enrollment 10.15.21.pdf Supplementary Document Uploaded 2021-10-15 Repair queued
1205-0548 Supporting Statement 031422.docx Supporting Statement A Uploaded 2022-03-14 Available
IC Document Collections
IC IDCollectionTypeStatusForm
249488 Student Vaccination Certification and Testing Consent Form Modified
249486 COVID-19 Emotional Wellness -- Students Other-Attestation Unchanged
249485 COVID-19 Symptom Tracker -- Students Other-Attestation Unchanged
ICR Details
1205-0548 202207-1205-003
Received in OIRA 202202-1205-002
DOL/ETA
COVID-19 Symptom Tracker for Students, Emotional Wellness Form for Students, and Student Vaccination Status and Test Consent Form Collection
No material or nonsubstantive change to a currently approved collection   No
Regular 07/18/2022
  Requested Previously Approved
04/30/2025 04/30/2025
14,680,000 14,680,000
4,844,400 4,844,400
0 0
This collection supplements Job Corps’ existing health collections to gather information that will allow Job Corps to safely mitigate the spread of COVID-19 and protect the safety and health of students during the ongoing pandemic.
US Code: 20 USC 686.530(d) Name of Law: Workforce Innovation and Opportunity Act
  
None
Not associated with rulemaking
  86 FR 71928 12/20/2021
87 FR 14578 03/15/2022
Yes
  Total Request 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 14,680,000 14,680,000 0 0 0 0
Annual Time Burden (Hours) 4,844,400 4,844,400 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$0
No
    No
    No
No
No
No
Yes
Emily St. Onge 202 693-2605 [email protected]
  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.
07/18/2022