Youth Conservation Corps Application and Medical History Forms

Forms and Documents

Document Name	Status
Form DI-4015 DI-4015, Youth Conservation Corps Medical History Form Form and Instruction	Modified
Form DI-4014 DI-4014, Youth Conservation Corps Application Form and Instruction	Modified
PUBLISHED 30 DAY NOTICE ICR 1093-0010 (88 FR 55718).pdf Supplementary Document	2023-11-06
Published 60 Day Notice ICR 1093-0010 (88 FR 20548).pdf Supplementary Document	2023-11-06
1093-0010 YCC SSA -7262023.docx Supporting Statement A	2023-11-06
SORN Interior OS-29 10161986 51FR36862.pdf Supplementary Document	2020-07-06
SORN Interior OS-25 08221991 56FR41700.pdf Supplementary Document	2020-07-06
YCC 16 U.S.C. §§ 1701-1706 (1982).pdf Supplementary Document	2020-07-06

IC Document Collections

IC ID	Document Title	Status
242577	DI-4015, Youth Conservation Corps Medical History Form Form and Instruction	Modified
242576	DI-4014, Youth Conservation Corps Application Form and Instruction	Modified

ICR Details

OMB Control No: 1093-0010	ICR Reference No: 202311-1093-001
Status: Received in OIRA	Previous ICR Reference No: 202101-1093-001
Agency/Subagency: DOI/OS	Agency Tracking No: 1093-YCC
Title: Youth Conservation Corps Application and Medical History Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  Yes
Type of Review Request: Regular	Date Submitted to OIRA: 11/06/2023

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2023
Responses	11,409	11,409
Time Burden (Hours)	4,239	4,239
Cost Burden (Dollars)	0	0

---

Abstract: 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).

---

Authorizing Statute(s): US Code: 16 USC 1701-1706, Chapter 37 Name of Law: Youth Conservation Corps and Public Lands Corps
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 20548	04/06/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 55718	08/16/2023
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
DI-4014, Youth Conservation Corps Application	DI-4014	YCC Application Form
DI-4015, Youth Conservation Corps Medical History Form	DI-4015	YCC Medical History Form

---

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	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

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:

---

Annual Cost to Federal Government: $245,072

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.     Yes

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.     Yes

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? No

---

Common Form ICR:  Yes

Description/Changes for Common Form Usage: 

Approved RCFs using this ICR

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:

(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: 11/06/2023

---