Information Collection

Baseline Data Collection, Staff

IC 197678 under ICR 201203-1205-011 · OMB 1205-0481.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
GJHC Participant Consent Form 3-9-12 (Final).doc	Other-participant consent form
Green Jobs Baseline Information Form (3-9-12 FINAL).doc	Other-Baseline Information form
GJ-HC Informed Consent Script to OMB 3-9-12.doc	Other-informed consent script

IC Title:

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:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-participant consent form	Yes	Yes	Paper Only
Other-Baseline Information form	Yes	Yes	Fillable Fileable
Other-informed consent script	Yes	Yes	Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	16	-5,984	6,000
Annual IC Time Burden (Hours)	768	-532	1,300
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
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.

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