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OMB Control No: 1205-0033	ICR Reference No: 202606-1205-002
Status: Received in OIRA	Previous ICR Reference No: 202503-1205-004
Agency/Subagency: DOL/ETA	Agency Tracking No:
Title: Job Corps Health Questionnaire
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/16/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	12/31/2026
Responses	32,458	66,630
Time Burden (Hours)	6,492	16,658
Cost Burden (Dollars)	0	0

ICR Summary of Burden

	Total Request	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	32,458	66,630	-34,172
Annual Time Burden (Hours)	6,492	16,658	-10,166
Annual Cost Burden (Dollars)	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Form ETA-653 has transitioned from paper to a digital format within the MyJobCorps system as of March 27, 2026.

Annual Cost to Federal Government: $2,312,257

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. 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: Patrice Gibson 202 693-0158 gibson.patrice.a@dol.gov

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