Baseline Data Collection, Staff

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⚠️ Notice: This information collection may be referencing outdated material.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
GJHC Participant Consent Form 6-30-11 (Final Clean).doc Other-consent form
GJ-HC Informed Consent Script to OMB 07-15-11.doc Other-informed consent script
Green Jobs Baseline Information Form (7-15-11 FINAL).doc Other-baseline information

Information Collection (IC) Details

IC Title:	Baseline Data Collection, Staff	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-consent form	GJHC Participant Consent Form 6-30-11 (Final Clean).doc	No		Printable Only
Other-informed consent script	GJ-HC Informed Consent Script to OMB 07-15-11.doc	Yes	No	Printable Only
Other-baseline information	Green Jobs Baseline Information Form (7-15-11 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: 24	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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.