COVID-19 Symptom Tracker for Students, Emotional Wellness Form for Students, and Student Vaccination Status and Test Consent Form Collection

Forms and Documents

Document Name	Status
Form ETA 9197 Student Vaccination Certification and Testing Consent Form	Modified
Form 9197 071222 tracked.docx Supplementary Document	2022-07-18
Program Instruction Notice 21-12 Aligning with CDC IHE.pdf Supplementary Document	2022-07-18
Justification for Non-Material Change 071822.docx Justification for No Material/Nonsubstantive Change	2022-07-18
PIN 21-04 Resumption of Traditional Enrollment 10.15.21.pdf Supplementary Document	2021-10-15
1205-0548 Supporting Statement 031422.docx Supporting Statement A	2022-03-14

IC Document Collections

IC ID	Document Title	Status
249488	Student Vaccination Certification and Testing Consent Form	Modified
249486	COVID-19 Emotional Wellness -- Students Other-Attestation	Unchanged
249485	COVID-19 Symptom Tracker -- Students Other-Attestation	Unchanged

ICR Details

OMB Control No: 1205-0548	ICR Reference No: 202207-1205-003
Status: Received in OIRA	Previous ICR Reference No: 202202-1205-002
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: COVID-19 Symptom Tracker for Students, Emotional Wellness Form for Students, and Student Vaccination Status and Test Consent Form Collection
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 07/18/2022

	Requested	Previously Approved
Expiration Date	04/30/2025	04/30/2025
Responses	14,680,000	14,680,000
Time Burden (Hours)	4,844,400	4,844,400
Cost Burden (Dollars)	0	0

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Abstract: This collection supplements Job Corps’ existing health collections to gather information that will allow Job Corps to safely mitigate the spread of COVID-19 and protect the safety and health of students during the ongoing pandemic.

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Authorizing Statute(s): US Code: 20 USC 686.530(d) Name of Law: Workforce Innovation and Opportunity Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 71928	12/20/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 14578	03/15/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
COVID-19 Emotional Wellness -- Students
COVID-19 Symptom Tracker -- Students
Student Vaccination Certification and Testing Consent	ETA 9197	Job Corps COVID-19 Symptom Tracker and Attestation

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ICR Summary of Burden

	Total Request	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	14,680,000	14,680,000	0	0	0	0
Annual Time Burden (Hours)	4,844,400	4,844,400	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Yes

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/18/2022

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