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Baseline Data Collection
Green Jobs and Health Care Impact Evaluation of ARRA-funded Grants
OMB: 1205-0481
IC ID: 197676
OMB.report
DOL/ETA
OMB 1205-0481
ICR 201105-1205-002
IC 197676
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0481 can be found here:
2012-05-10 - No material or nonsubstantive change to a currently approved collection
2011-12-29 - Extension without change of a currently approved collection
Documents and Forms
Document Name
Document Type
GJHC Participant Consent Form 6-30-11 (Final Clean).doc
Other-consent form
Green Jobs Baseline Information Form (7-15-11 FINAL).doc
Other-baseline information
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Baseline Data Collection
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-baseline information
Green Jobs Baseline Information Form (7-15-11 FINAL).doc
Yes
Yes
Fillable Fileable
Other-consent form
GJHC Participant Consent Form 6-30-11 (Final Clean).doc
No
Printable Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Workforce Management
Subfunction:
Training and Employment
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
6,000
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
90 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
6,000
0
6,000
0
0
0
Annual IC Time Burden (Hours)
1,300
0
1,300
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
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.