Information Collection

Job Corps Application Data

IC 12941 under ICR 201612-1205-003 · OMB 1205-0025.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1205-0025 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form ETA 652 Job Corps Application Data	Form and Instruction
ETA 652 Job Corps Data Sheet ETA 652 Job Corps Data Sheet.doc	Form and Instruction
ETA 655 Statement from Court or Other Agency ETA 655 Statement from Court or Other Agency.doc	Form and Instruction
ETA 682 Child Care Certification ETA 682 Child Care Certification.doc	Form and Instruction

IC Title:

Job Corps Application Data

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	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 652	Job Corps Data Sheet	ETA 652 Job Corps Data Sheet.doc	Yes	Yes	Fillable Printable
Form and Instruction	ETA 655	Statement from Court or Other Agency	ETA 655 Statement from Court or Other Agency.doc	Yes	Yes	Fillable Printable
Form and Instruction	ETA 682	Child Care Certification	ETA 682 Child Care Certification.doc	Yes	Yes	Fillable Printable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records

Title: DOL/GOVT-2

FR Citation: 67 FR 16829

Number of Respondents: 139,955

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	139,955	-39,768	179,723
Annual IC Time Burden (Hours)	12,556	-3,645	16,201
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.