Youth Conservation Corps Application and Medical History Forms

ICR 202307-1093-001

OMB: 1093-0010

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Unchanged
Form and Instruction
Unchanged
Supplementary Document
2023-08-16
Supporting Statement A
2023-07-27
Supplementary Document
2023-07-27
Supplementary Document
2020-07-06
Supplementary Document
2020-07-06
Supplementary Document
2020-07-06
ICR Details
1093-0010 202307-1093-001
Received in OIRA 202101-1093-001
DOI/OS 1093-YCC
Youth Conservation Corps Application and Medical History Forms
Extension without change of a currently approved collection   Yes
Regular 08/16/2023
  Requested Previously Approved
36 Months From Approved 10/31/2023
11,409 11,409
4,239 4,239
0 0

Under the Youth Conservation Corps Act of August 13, 1970, as amended (U.S. 1701–1706), the U.S. Department of Interior and the U.S. Department of Agriculture-U.S. Forest Service provide seasonal employment for eligible youth 15 through 18 years old. The Youth Conservation Corps stresses three important objectives: 1. Accomplish needed conservation work on public lands; 2. Provide gainful employment for 15 to 18 year-old males and females from all social, economic, ethnic, and racial backgrounds; and 3. Foster, on the part of the 15 through 18 year-old youth, an understanding and appreciation of the Nation’s natural resources and heritage. Youths seeking training and employment with the Youth Conservation Corps must complete the following new common forms included in this emergency clearance request: DI-4014, “Youth Conservation Corps Application” and DI-4015, “Youth Conservation Corps Medical History.” The applicants’ parents or guardians must sign both forms. The application and medical history forms are evaluated by participating agencies to determine the eligibility of each youth for employment with the Youth Conservation Corps. Potential and actual agencies that may use the common forms included in this collection include: • U.S. Fish and Wildlife Service (Interior); • National Park Service (Interior); and, • Other Federal Departments and Agencies such as the U.S. Forest Service (U.S. Department of Agriculture).

US Code: 16 USC 1701-1706, Chapter 37 Name of Law: Youth Conservation Corps and Public Lands Corps
  
None

Not associated with rulemaking

  88 FR 20548 04/06/2023
88 FR 55718 08/16/2023
No

  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 11,409 11,409 0 0 0 0
Annual Time Burden (Hours) 4,239 4,239 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$245,072
No
    Yes
    Yes
No
No
No
No
Jeffrey Parrillo 202 208-7072 [email protected]

  Yes
  The application and medical history forms are evaluated by participating agencies to determine the eligibility of each youth for employment with the Youth Conservation Corps. Potential and actual agencies that may use the common forms included in this collection include: • U.S. Fish and Wildlife Service (Interior); • National Park Service (Interior); and, • Other Federal Departments and Agencies such as the U.S. Forest Service (U.S. Department of Agriculture).
Agency/Sub Agency RCF ID RCF Title RCF Status IC Title

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/16/2023


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