Job Corps Health Questionnaire

Job Corps Health Questionnaire

OMB: 1205-0033

IC ID: 12954

Information Collection (IC) Details

View Information Collection (IC)

Job Corps Health Questionnaire
 
No Modified
 
Required to Obtain or Retain Benefits
 
20 CFR 670.965

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction ETA 653 Health Questionnaire ETA 653 Job Corps Health Questionnaire_FINAL 5.24.17.docx Yes Yes Fillable Fileable

Workforce Management Training and Employment

DOL/GOVT-2  81 FR 25765

66,697 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 66,697 0 0 -20,884 0 87,581
Annual IC Time Burden (Hours) 8,893 0 0 1,595 0 7,298
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
ETA 653 - Job Corps Health Questionnaire (track changes) ETA 653_(track changes) 5.24.17.docx 05/25/2017
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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