Job Corps Health Questionnaire

Documents and Forms

Document Name Document Type
Form ETA 653 Job Corps Health Questionnaire Form and Instruction
ETA 653 Job Corps Health Questionnaire Form ETA 653 BAH version.docx Form and Instruction
ETA 653 Job Corps Health Questionnaire Form ETA 653 - 11.29.2023.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Job Corps Health Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 20 CFR 670.965

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	ETA 653	Job Corps Health Questionnaire	Form ETA 653 - 11.29.2023.docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

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

Number of Respondents: 66,630	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	66,630	0	66,630
Annual IC Time Burden (Hours)	16,658	7,774	8,884
Annual IC Cost Burden (Dollars)	0	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.