Information Collection Request

Standard Job Corps Contractor Information Gathering

ICR 202411-1205-003 · OMB 1205-0219 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form ETA 9190A, 9190B a Grant Data Collection Form Form New Available
Form ETA 9190A, 9190B a Performance Form New Repair queued
Form ETA 9215 Physical Examination Form Form New Available
Form ETA 9213 Immunization Record Form New Available
Form ETA 9217 Lab Testing Information Sheet Form New Available
Form ETA 9216 Health History Form Form New Available
Form ETA 9214 Social Intake Form Form New Available
Form ETA 9212 Alcohol Testing Report Form New Available
Form ETA 9222 Health and Wellness Center Annual Program Description Form New Available
Form ETA 9222 Health and Wellness Form New Repair queued
Form ETA 2181 Center Operations Bugget Form New Available
Form ETA 2110 S Center Vacancy Separation Report Form New Available
Form ETA 2110 Center Financial Report Form New Available
Form ETA 2110 Finance Form New Repair queued
Form ETA 328 Property Inventory Form New Available
Form ETA 9220 Center Preventive Maintenance Plan (PMP) Form New Available
Form ETA 9221 Construction and Rehab Report (CRA) Form and Instruction New Available
Form ETA 6-39 Inspection of Waste Treatment Facilities Cost Form New Available
Form ETA 6-38 Inspection of Water Supply Facilities Form New Available
Form ETA 6-37 Inspection of Residential and Educational Facilities Form New Available
Form ETA 6-36 Environmental Health Inspections Form New Available
Form ETA 6-36 Facilities and Asset Management Form New Repair queued
Form ETA 9218 CDSS Center Operations Plan Form New Available
Form ETA 661 Student Separation Form New Available
Form ETA 640 Student Profile Form New Available
Form ETA 6-131C Right to Appeal Form New Available
Form ETA 6-131 A & B Disciplinary Discharge and Review Board Hearings Form New Available
Form ETA 6-131 A & B Center Form New Missing upstream
Form ETA 9219 Annual Career Technical Skills Training Form New Available
Form ETA 9219 Career Technical Training (CTT) Form New Available
Form ETA 6-39 Inspection of Waste Water Treatment Facilities Form Removed Available
Form ETA 6-38 Inspection of Water and Supply Facilities Form Removed Available
Form ETA 6-37 Inspection of Residential and Educational Facilities Form Removed Available
Form ETA 6-36 Environmental Health Inspection Form Removed Available
Form ETA 9190 Grants Data Collection Forms Form Removed Available
Form ETA 2181 Center Operations Budget Form Removed Available
Form ETA 2110 Center Financial Report Form Removed Available
Form ETA 661 Student Seperation Form Removed Available
Form ETA 9192 Annual Center Academic Programs Review and Planning Form Removed Available
Form ETA 640 Student Profile Form Removed Available
Form ETA 328 Property Inventory Form Removed Available
Form ETA 6-131C Right to Appeal Form Removed Available
Form ETA 6-131A and 6-1 Disciplinary Discharge Form Removed Available
Form ETA 6-131A and 6-1 Standard Job Corps reporting forms Form Removed Repair queued
1205-0219_Supporting Statement_11.15.24.docx Supporting Statement A Uploaded 2024-11-15 Available
1205-0219_Supporting Statement_11.15.24.docx Supporting Statement A Uploaded 2024-11-15 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
272422 Performance Form NewGrant Data Collection Form
272422 Performance Form New
272405 Health and Wellness Form NewPhysical Examination Form
272405 Health and Wellness Form NewImmunization Record
272405 Health and Wellness Form NewLab Testing Information Sheet
272405 Health and Wellness Form NewHealth History Form
272405 Health and Wellness Form NewSocial Intake Form
272405 Health and Wellness Form NewAlcohol Testing Report
272405 Health and Wellness Form NewHealth and Wellness Center Annual Program Description
272405 Health and Wellness Form New
272391 Finance Form NewCenter Operations Bugget
272391 Finance Form NewCenter Vacancy Separation Report
272391 Finance Form NewCenter Financial Report
272391 Finance Form New
272313 Facilities and Asset Management Form NewProperty Inventory
272313 Facilities and Asset Management Form NewCenter Preventive Maintenance Plan (PMP)
272313 Facilities and Asset Management Form and Instruction NewConstruction and Rehab Report (CRA)
272313 Facilities and Asset Management Form NewInspection of Waste Treatment Facilities Cost
272313 Facilities and Asset Management Form NewInspection of Water Supply Facilities
272313 Facilities and Asset Management Form NewInspection of Residential and Educational Facilities
272313 Facilities and Asset Management Form NewEnvironmental Health Inspections
272313 Facilities and Asset Management Form New
272312 Center Form NewCDSS Center Operations Plan
272312 Center Form NewStudent Separation
272312 Center Form NewStudent Profile
272312 Center Form NewRight to Appeal
272312 Center Form NewDisciplinary Discharge and Review Board Hearings
272312 Center Form New
272311 Career Technical Training (CTT) Form NewAnnual Career Technical Skills Training
272311 Career Technical Training (CTT) Form New
13047 Standard Job Corps reporting forms Form RemovedInspection of Waste Water Treatment Facilities
13047 Standard Job Corps reporting forms Form RemovedInspection of Water and Supply Facilities
13047 Standard Job Corps reporting forms Form RemovedInspection of Residential and Educational Facilities
13047 Standard Job Corps reporting forms Form RemovedEnvironmental Health Inspection
13047 Standard Job Corps reporting forms Form RemovedGrants Data Collection Forms
13047 Standard Job Corps reporting forms Form RemovedCenter Operations Budget
13047 Standard Job Corps reporting forms Form RemovedCenter Financial Report
13047 Standard Job Corps reporting forms Form RemovedStudent Seperation
13047 Standard Job Corps reporting forms Form RemovedAnnual Center Academic Programs Review and Planning
13047 Standard Job Corps reporting forms Form RemovedStudent Profile
13047 Standard Job Corps reporting forms Form RemovedProperty Inventory
13047 Standard Job Corps reporting forms Form RemovedRight to Appeal
13047 Standard Job Corps reporting forms Form RemovedDisciplinary Discharge
13047 Standard Job Corps reporting forms Form Removed
ICR Details
1205-0219 202411-1205-003
Active 202202-1205-001
DOL/ETA
Standard Job Corps Contractor Information Gathering
Revision of a currently approved collection   No
Regular
Approved without change 03/27/2026
Retrieve Notice of Action (NOA) 05/09/2025
  Inventory as of this Action Requested Previously Approved
03/31/2029 36 Months From Approved 03/31/2026
426,663 0 277,298
134,919 0 83,640
0 0 0

These operating and/or reporting forms are standard for the operation of a Job Corps Center. They are Federal information collection requirements for operators of such centers. Job Corps has automated the following Employment and Training Administration (ETA) forms: 2110, 2181, 6-131A, 6-131B, 6-131C, 640, 661, and 328.

PL: Pub.L. 113 - 128 Subtitle C, 141 et seq Name of Law: Workforce Innovation and Opportunity Act
   PL: Pub.L. 105 - 220 Subtitle C, 141 et seq Name of Law: Workforce Investment Act of 1998
  
None

Not associated with rulemaking

  89 FR 66741 08/16/2024
90 FR 21348 05/19/2025
No

6
IC Title Form No. Form Name
Career Technical Training (CTT) ETA 9219 Annual Career Technical Skills Training
Center ETA 9218, ETA 6-131 A & B, ETA 6-131C, ETA 640, ETA 661 Disciplinary Discharge and Review Board Hearings ,   Right to Appeal ,   Student Profile ,   Student Separation ,   CDSS Center Operations Plan
Facilities and Asset Management ETA 6-37, ETA 9220, ETA 6-36, ETA 6-38, ETA 6-39, ETA 9221, ETA 328 Environmental Health Inspections ,   Inspection of Residential and Educational Facilities ,   Inspection of Water Supply Facilities ,   Inspection of Waste Treatment Facilities Cost ,   Construction and Rehab Report (CRA) ,   Center Preventive Maintenance Plan (PMP) ,   Property Inventory
Finance ETA 2110, ETA 2110 S, ETA 2181 Center Financial Report ,   Center Vacancy Separation Report ,   Center Operations Bugget
Health and Wellness ETA 9212, ETA 9222, ETA 9215, ETA 9214, ETA 9216, ETA 9217, ETA 9213 Health and Wellness Center Annual Program Description ,   Alcohol Testing Report ,   Social Intake Form ,   Health History Form ,   Lab Testing Information Sheet ,   Immunization Record ,   Physical Examination Form
Performance ETA 9190A, 9190B and 9190C Grant Data Collection Form
Standard Job Corps reporting forms ETA 9190 , ETA 661, ETA 6-131A and 6-131B, ETA 6-131C, ETA 328, ETA 640, ETA 9192, ETA 2110 , ETA 2181, ETA 6-36, ETA 6-37, ETA 6-38, ETA 6-39 Disciplinary Discharge ,   Right to Appeal ,   Property Inventory ,   Student Profile ,   Annual Center Academic Programs Review and Planning ,   Student Seperation ,   Center Financial Report ,   Center Operations Budget ,   Grants Data Collection Forms ,   Environmental Health Inspection ,   Inspection of Residential and Educational Facilities ,   Inspection of Water and Supply Facilities ,   Inspection of Waste Water Treatment Facilities

  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 426,663 277,298 0 149,365 0 0
Annual Time Burden (Hours) 134,919 83,640 0 51,279 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The previously approved total annual burden hours were 83,640 hours, and this request notes 134,919 hours. An increase of 51,279 hours. Please see detailed response in supporting statement.

$2,700,000
No
    No
    No
No
No
No
No
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.
05/09/2025