Standard Job Corps Contractor Information Gathering

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form ETA 9190A, 9190B a Grant Data Collection Form	Form	New	Available
Form ETA 9190A, 9190B a Performance	Form	New	Repair queued
Form ETA 9215 Physical Examination Form	Form	New	Available
Form ETA 9213 Immunization Record	Form	New	Available
Form ETA 9217 Lab Testing Information Sheet	Form	New	Available
Form ETA 9216 Health History Form	Form	New	Available
Form ETA 9214 Social Intake Form	Form	New	Available
Form ETA 9212 Alcohol Testing Report	Form	New	Available
Form ETA 9222 Health and Wellness Center Annual Program Description	Form	New	Available
Form ETA 9222 Health and Wellness	Form	New	Repair queued
Form ETA 2181 Center Operations Bugget	Form	New	Available
Form ETA 2110 S Center Vacancy Separation Report	Form	New	Available
Form ETA 2110 Center Financial Report	Form	New	Available
Form ETA 2110 Finance	Form	New	Repair queued
Form ETA 328 Property Inventory	Form	New	Available
Form ETA 9220 Center Preventive Maintenance Plan (PMP)	Form	New	Available
Form ETA 9221 Construction and Rehab Report (CRA)	Form and Instruction	New	Available
Form ETA 6-39 Inspection of Waste Treatment Facilities Cost	Form	New	Available
Form ETA 6-38 Inspection of Water Supply Facilities	Form	New	Available
Form ETA 6-37 Inspection of Residential and Educational Facilities	Form	New	Available
Form ETA 6-36 Environmental Health Inspections	Form	New	Available
Form ETA 6-36 Facilities and Asset Management	Form	New	Repair queued
Form ETA 9218 CDSS Center Operations Plan	Form	New	Available
Form ETA 661 Student Separation	Form	New	Available
Form ETA 640 Student Profile	Form	New	Available
Form ETA 6-131C Right to Appeal	Form	New	Available
Form ETA 6-131 A & B Disciplinary Discharge and Review Board Hearings	Form	New	Available
Form ETA 6-131 A & B Center	Form	New	Repair queued
Form ETA 9219 Annual Career Technical Skills Training	Form	New	Available
Form ETA 9219 Career Technical Training (CTT)	Form	New	Available
Form ETA 6-39 Inspection of Waste Water Treatment Facilities	Form	Removed	Available
Form ETA 6-38 Inspection of Water and Supply Facilities	Form	Removed	Available
Form ETA 6-37 Inspection of Residential and Educational Facilities	Form	Removed	Available
Form ETA 6-36 Environmental Health Inspection	Form	Removed	Available
Form ETA 9190 Grants Data Collection Forms	Form	Removed	Available
Form ETA 2181 Center Operations Budget	Form	Removed	Available
Form ETA 2110 Center Financial Report	Form	Removed	Available
Form ETA 661 Student Seperation	Form	Removed	Available
Form ETA 9192 Annual Center Academic Programs Review and Planning	Form	Removed	Available
Form ETA 640 Student Profile	Form	Removed	Available
Form ETA 328 Property Inventory	Form	Removed	Available
Form ETA 6-131C Right to Appeal	Form	Removed	Available
Form ETA 6-131A and 6-1 Disciplinary Discharge	Form	Removed	Available
Form ETA 6-131A and 6-1 Standard Job Corps reporting forms	Form	Removed	Repair queued
1205-0219_Supporting Statement_11.15.24.docx	Supporting Statement A	Uploaded 2024-11-15	Available
1205-0219_Supporting Statement_11.15.24.docx	Supporting Statement A	Uploaded 2024-11-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
272422	Performance	Form	New	Grant Data Collection Form
272422	Performance	Form	New
272405	Health and Wellness	Form	New	Physical Examination Form
272405	Health and Wellness	Form	New	Immunization Record
272405	Health and Wellness	Form	New	Lab Testing Information Sheet
272405	Health and Wellness	Form	New	Health History Form
272405	Health and Wellness	Form	New	Social Intake Form
272405	Health and Wellness	Form	New	Alcohol Testing Report
272405	Health and Wellness	Form	New	Health and Wellness Center Annual Program Description
272405	Health and Wellness	Form	New
272391	Finance	Form	New	Center Operations Bugget
272391	Finance	Form	New	Center Vacancy Separation Report
272391	Finance	Form	New	Center Financial Report
272391	Finance	Form	New
272313	Facilities and Asset Management	Form	New	Property Inventory
272313	Facilities and Asset Management	Form	New	Center Preventive Maintenance Plan (PMP)
272313	Facilities and Asset Management	Form and Instruction	New	Construction and Rehab Report (CRA)
272313	Facilities and Asset Management	Form	New	Inspection of Waste Treatment Facilities Cost
272313	Facilities and Asset Management	Form	New	Inspection of Water Supply Facilities
272313	Facilities and Asset Management	Form	New	Inspection of Residential and Educational Facilities
272313	Facilities and Asset Management	Form	New	Environmental Health Inspections
272313	Facilities and Asset Management	Form	New
272312	Center	Form	New	CDSS Center Operations Plan
272312	Center	Form	New	Student Separation
272312	Center	Form	New	Student Profile
272312	Center	Form	New	Right to Appeal
272312	Center	Form	New	Disciplinary Discharge and Review Board Hearings
272312	Center	Form	New
272311	Career Technical Training (CTT)	Form	New	Annual Career Technical Skills Training
272311	Career Technical Training (CTT)	Form	New
13047	Standard Job Corps reporting forms	Form	Removed	Inspection of Waste Water Treatment Facilities
13047	Standard Job Corps reporting forms	Form	Removed	Inspection of Water and Supply Facilities
13047	Standard Job Corps reporting forms	Form	Removed	Inspection of Residential and Educational Facilities
13047	Standard Job Corps reporting forms	Form	Removed	Environmental Health Inspection
13047	Standard Job Corps reporting forms	Form	Removed	Grants Data Collection Forms
13047	Standard Job Corps reporting forms	Form	Removed	Center Operations Budget
13047	Standard Job Corps reporting forms	Form	Removed	Center Financial Report
13047	Standard Job Corps reporting forms	Form	Removed	Student Seperation
13047	Standard Job Corps reporting forms	Form	Removed	Annual Center Academic Programs Review and Planning
13047	Standard Job Corps reporting forms	Form	Removed	Student Profile
13047	Standard Job Corps reporting forms	Form	Removed	Property Inventory
13047	Standard Job Corps reporting forms	Form	Removed	Right to Appeal
13047	Standard Job Corps reporting forms	Form	Removed	Disciplinary Discharge
13047	Standard Job Corps reporting forms	Form	Removed

ICR Details

OMB Control No: 1205-0219	ICR Reference No: 202411-1205-003
Status: Active	Previous ICR Reference No: 202202-1205-001
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Standard Job Corps Contractor Information Gathering
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/27/2026
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/09/2025
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2029	36 Months From Approved	03/31/2026
Responses	426,663	0	277,298
Time Burden (Hours)	134,919	0	83,640
Cost Burden (Dollars)	0	0	0

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Abstract: These operating and/or reporting forms are standard for the operation of a Job Corps Center. They are Federal information collection requirements for operators of such centers. Job Corps has automated the following Employment and Training Administration (ETA) forms: 2110, 2181, 6-131A, 6-131B, 6-131C, 640, 661, and 328.

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Authorizing Statute(s): PL: Pub.L. 113 - 128 Subtitle C, 141 et seq Name of Law: Workforce Innovation and Opportunity Act
   PL: Pub.L. 105 - 220 Subtitle C, 141 et seq Name of Law: Workforce Investment Act of 1998
  

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:
	89 FR 66741	08/16/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 21348	05/19/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Career Technical Training (CTT)	ETA 9219	Annual Career Technical Skills Training
Center	ETA 9218, ETA 6-131 A & B, ETA 6-131C, ETA 640, ETA 661	Disciplinary Discharge and Review Board Hearings ,   Right to Appeal ,   Student Profile ,   Student Separation ,   CDSS Center Operations Plan
Facilities and Asset Management	ETA 6-37, ETA 9220, ETA 6-36, ETA 6-38, ETA 6-39, ETA 9221, ETA 328	Environmental Health Inspections ,   Inspection of Residential and Educational Facilities ,   Inspection of Water Supply Facilities ,   Inspection of Waste Treatment Facilities Cost ,   Construction and Rehab Report (CRA) ,   Center Preventive Maintenance Plan (PMP) ,   Property Inventory
Finance	ETA 2110, ETA 2110 S, ETA 2181	Center Financial Report ,   Center Vacancy Separation Report ,   Center Operations Bugget
Health and Wellness	ETA 9212, ETA 9222, ETA 9215, ETA 9214, ETA 9216, ETA 9217, ETA 9213	Health and Wellness Center Annual Program Description ,   Alcohol Testing Report ,   Social Intake Form ,   Health History Form ,   Lab Testing Information Sheet ,   Immunization Record ,   Physical Examination Form
Performance	ETA 9190A, 9190B and 9190C	Grant Data Collection Form
Standard Job Corps reporting forms	ETA 9190 , ETA 661, ETA 6-131A and 6-131B, ETA 6-131C, ETA 328, ETA 640, ETA 9192, ETA 2110 , ETA 2181, ETA 6-36, ETA 6-37, ETA 6-38, ETA 6-39	Disciplinary Discharge ,   Right to Appeal ,   Property Inventory ,   Student Profile ,   Annual Center Academic Programs Review and Planning ,   Student Seperation ,   Center Financial Report ,   Center Operations Budget ,   Grants Data Collection Forms ,   Environmental Health Inspection ,   Inspection of Residential and Educational Facilities ,   Inspection of Water and Supply Facilities ,   Inspection of Waste Water Treatment Facilities

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ICR Summary of Burden

table that charts list of burden

	Total Approved	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	426,663	277,298	0	149,365	0	0
Annual Time Burden (Hours)	134,919	83,640	0	51,279	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The previously approved total annual burden hours were 83,640 hours, and this request notes 134,919 hours. An increase of 51,279 hours. Please see detailed response in supporting statement.

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Annual Cost to Federal Government: $2,700,000

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? No

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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: 05/09/2025

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