Student Vaccination Certification and Testing Consent

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

Documents and Forms

Document Name Document Type
Form ETA 9197 Student Vaccination Certification and Testing Consent Form
ETA 9197 Job Corps COVID-19 Symptom Tracker and Attestation Form 9197 071222 clean.docx Form
ETA 9197 Job Corps COVID-19 Symptom Tracker and Attestation Form 9197 071222 clean.docx Form

Information Collection (IC) Details

IC Title:	Student Vaccination Certification and Testing Consent	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	ETA 9197	Job Corps COVID-19 Symptom Tracker and Attestation	Form 9197 071222 clean.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: DOL/GOVT-2 Job Corps Student Records	FR Citation: 81 FR 25765

Number of Respondents: 20,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Requested	Previously Approved
Annual Number of Responses for this IC	80,000	80,000
Annual IC Time Burden (Hours)	26,400	26,400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.