View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
1093-0010
ICR Reference No:
202001-1093-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
DOI/OS
Agency Tracking No:
1093-YCC
Title:
Youth Conservation Corps Application and Medical History Forms
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
Yes
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
10/30/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
08/21/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
10/31/2023
36 Months From Approved
Responses
11,409
0
0
Time Burden (Hours)
4,239
0
0
Cost Burden (Dollars)
0
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:
85 FR 5691
01/31/2020
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 51752
08/21/2020
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
United States Youth Conservation Corps - Crew Member Application
DI-4015, Youth Conservation Corps Medical History Form
DI-4015
Medical History Form
ICR Summary 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
11,409
0
0
11,409
0
0
Annual Time Burden (Hours)
4,239
0
0
4,239
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:
No
Burden Reduction Due to:
Short Statement:
This is a request for clearance of a new collection involving the use of two common forms used by the U.S. Department of the Interior and the U.S. Department of Agriculture – U.S. Forest Service.
Annual Cost to Federal Government:
$213,527
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
Agency Contact:
Jeffrey Parrillo 202 208-7072 jeffrey_parrillo@ios.doi.gov
Common Form ICR:
Yes
Description/Changes for Common Form Usage:
Participating agencies evaluate the application, upon submission by eligible youth, to select candidates to the program. This information collection requests OMB approval for two new common forms for use with the YCC Program. Youths seeking training and employment with YCC must first complete the application form DI-4014, “Youth Conservation Corps (YCC) Application.” Once selected for enrollment, the applicant is required to complete form DI-4015, “Youth Conservation Corps (YCC) Medical History.”
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:
08/21/2020
An official website of the United States government
The .gov means it's official.
The site is secure.
