Privacy Act Statement

Job Corps Privacy Act Statement final approved by OMB 2010.doc

Job Corps Health Questionnaire

Privacy Act Statement

OMB: 1205-0033

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U.S. DEPARTMENT OF LABOR

EMPLOYMENT AND TRAINING ADMINISTRATION






This statement applies to forms used by the Department of Labor for the Job Corps program that contain confidential data from Job Corps applicants and students.


This statement describes the collection and use of information from Job Corps applicants and students by the Department of Labor for the Job Corps program.


The Privacy Act of 1974, as amended, requires all Federal agencies, including Job Corps and its agents, to give the following facts to each person from whom it requires information:


The statutory authority for the request,


Why the information is needed,


Whether it is voluntary or mandatory to give the

information, The effect of not providing information,


The use which may be made of the information,


Whether disclosure of the Social Security Number (SSN)

is mandatory or voluntary, by what status or other

authority the number is solicited, and what uses will be

made of it


These items are more fully explained in the following sections. If you have any questions about your rights and responsibilities under the Privacy Act, you should ask for assistance from the person assigned to you in Job Corps as counselor or advisor.


I. The Department of Labor’s Authorization to Collect Information


Job Corps is a part of the U.S. Department of Labor. The Department’s authority to collect information from Job Corps applicants and Job Corps students is found in the Workforce Investment Act of 1998 (WIA). The Department’s authority to solicit the Social Security number is found in the Social Security Administration’s regulations, WIA and the Job Corps regulations under WIA.


II. Why the information is needed.


Job Corps needs information about age, citizenship, school

and draft status, health, employability, behavior, family income, environment, and other matters related to your eligibility, assignment, and process in Job Corps. The information may be used to:


determine whether your educational and vocational needs can best be met through the Job Corps or another program in your home community.


determine your potential assignment.


lay the basis for determining your progress in Job Corps programs and activities.


determine your medical eligibility to enter Job Corps or health needs (medical, dental and/or mental health) while




JOB CORPS PRIVACY ACT STATEMENT




a student and also to establish and maintain a record of your health care during the period of enrollment in Job corps for legal and administrative reasons, e.g., future

health care, indication of quality of health care, and for Federal Employee Compensation Act claims.


maintain a record of cash, clothing and other benefits received by the individual.


III. Obligatory and Voluntary Information and Possible

Consequences of Withholding Information or Providing

False Information.


While there are no penalties under the law for refusing to supply information, WIA requires the collection and maintenance of a wide range of personal information about you, including your Social Security number, to satisfy enrollment requirements. Not supplying the requested information could delay or prevent you from enrolling and participating in Job Corps.


The provision of false information by you could lead to expulsion from the program or prosecution under the U.S. Criminal Code when such information is used to support a fraudulent claim to benefits.


IV. How the Information is Used.


The SSN will be used for payroll allotment, allowances and bonuses. In carrying out it responsibilities under WIA to administer the Job Corps program, the Department of Labor must sometimes disclose data from its records about you to another agency or individual without your specific written consent. Such disclosures are made for the following reasons:


In connection with federal litigation, for law enforcement purposes.


To the parent locator service of the Department of HHS or to other authorized persons defined by Public Law 93-647.


To an information source in connection with personnel, procurement, or benefit-related matters, to a contractor or their employees, consultants, grantees or their employees, or volunteers who have been engaged to assist Job Corps in the performance of a contract.


For Federal debt collection purposes.


If a person about whom records are maintained submits a written request to a Member of Congress or their staff and that request is forwarded to the U.S. Department of Labor, we may release the information to the Member of Congress or Congressional staff in response to the inquiry made on behalf of the subject of the record.


To provide information to the news media or members of the general public for the purpose of promoting the merits of the program.



IV. How the Information is Used (Continued)


To provide information to placement and welfare agencies, prospective employers, school or training institutions to assist in student employment.


To provide information State, Federal, and local law enforcement agencies (including appropriate agencies

which have law enforcement jurisdiction over students on which the center is located) and other government

investigators to assist them in locating a student and/or his or her family.


To provide information to parents/guidance regarding students under the age of 18 for performance of parental rights and responsibilities.


To provide information to Job Corps health consultants; job Corps Center Review Board members (in appropriate disciplinary cases); State county and local health services personnel; family planning agencies; and physicians (public or private) to whom a student is referred for diagnosis or to receive treatment to assure continuance of proper health care, or notification and contract for communicable disease control.


To provide State and local health departments information about all cases of infection or disease that are required to be reported to them; and infected persons who are unwilling to notify their contacts on center for the purpose of assisting in the counseling of contacts for their protection and care.


To provide information to contracts and agencies to enable them to properly administer the program, including the payment of student allowances and maintenance and disposal of student pay records.


To provide information, with the student’s voluntary consent,  to Federal, State and local agencies and community-based organizations to facilitate statistical research, audit and evaluation activities necessary to insure the success, integrity and improvement of the Job Corps program and other employment and training programs.


To provide the Selective Service System with information which will allow them to register you automatically for Selective Service when you become 18, if you are a male and are not already registered.


For research purposes. Privacy Act information collected from the student shall not be used in any study or research project unless it has been approved by the Department, or freely given by the student with his or her consent.


Job Corps has given you a copy of this statement, in accordance with the Privacy Act of 1974, as amended, which explains the users that will be made of information that you or others might supply Job Corps about yourself.


A single copy of this form must be given to the student for personal reference upon enrollment.












October 8, 2010

File Typeapplication/msword
Authorfitzhugh.marsha
Last Modified Byfitzhugh.marsha
File Modified2010-11-15
File Created2010-10-08

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