JOB CORPS HEALTH QUESTIONNAIRE

ICR 197709-1205-002

OMB: 1205-0033

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
120655 Migrated
ICR Details
1205-0033 197709-1205-002
Historical Active 197709-1205-001
DOL/ETA
JOB CORPS HEALTH QUESTIONNAIRE
Revision of a currently approved collection   No
Regular
Approved without change 09/27/1977
Retrieve Notice of Action (NOA) 09/22/1977
  Inventory as of this Action Requested Previously Approved
08/31/1982 08/31/1982 12/31/1977
100,000 0 100,000
33,000 0 33,000
0 0 0

THE JOB CORPS HEALTH QUESTIONNAIRE IS USED TO OBTAIN THE HEALTH HISTORY OF ANY APPLICANT WHOSE ELIGIBILITY MAY BE IN DOUBT. ITS JUSTIFICATION IS CITED IN CETA, TITLE IV, SECT. 452: "TO BECOME AN ENROLLEE IN THE JOB CORPS, A YOUNG MAN OR WOMAN MUST BE AN ELIGIBLE YOUTH WHO IS DETERMINED...TO BE FREE OF MEDICAL AND BEHAVIORAL PROBLEMS SO SERIOUS THAT THE INDIVIDUAL COULD NOT ADJUST TO THE STANDARDS OF CONDUCT, DISCIPLINE, WORK, AND TRAINING WHICH THE JO

None
None


No

1
IC Title Form No. Form Name
JOB CORPS HEALTH QUESTIONNAIRE MA6-53

  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 100,000 100,000 0 0 0 0
Annual Time Burden (Hours) 33,000 33,000 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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.
09/22/1977


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