Statistical Clearance Form

U.S. DEPARTMENT OF LABOR
Chief Evaluation Office Concurrence of Surveys Employing Statistical Methods
TO:
Frederick C. Licari, OCIO/OASAM DATE PREPARED: 11/27/2019
PHONE: 202-693-8073
FROM: Scott Gibbons
PHONE: 202-693-5075
ACTION: Review the attached report proposal, indicate approval or disapproval, and return to
the sponsoring agency or program. Comments shall not be made on the proposed report but in
the comments space below.
TITLE OF SURVEY OR EVALUATION:
Evaluation of the National Health Emergency (NHE) Dislocated Worker Demonstration
Grants
CLEARANCE:
_X__ Approved
____ Disapproved (see below)
____ Approved with comments (see below)
COMMENTS:
(Insert additional pages as needed)

Disclaimer: CEO is approving only the statistical methodology as presented in the written documentation
and not necessarily passing judgment on the questionnaire itself nor on the necessity of conducting the
collection of information.

SIGNATURE OF REVIEWER