Baseline Data Collection

Green Jobs and Health Care Impact Evaluation of ARRA-funded Grants

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0481 can be found here:

Documents and Forms

Document Name Document Type
1205-0481 - Appendix A - Participant Consent Form final.doc Other-Participant Consent Form
1205-0481 - Appendix B - Baseline Information Form final.doc Other-survey

Information Collection (IC) Details

IC Title:	Baseline Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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-Participant Consent Form			1205-0481 - Appendix A - Participant Consent Form final.doc		Yes	Yes	Paper Only
Other-survey			1205-0481 - Appendix B - Baseline Information Form final.doc		Yes	Yes	Fillable Fileable

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	Previously Approved
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	1,300	1,300
Annual IC Cost Burden (Dollars)	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.