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OMB Control No: 1093-0010	ICR Reference No: 202609-1093-001
Status: Received in OIRA	Previous ICR Reference No: 202503-1093-001
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: 10/01/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved	11/30/2026
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:
	91 FR 14707	03/26/2026
30-day Notice:	Federal Register Citation:	Citation Date:
	91 FR 62546	10/01/2026
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
DI-4015, Youth Conservation Corps Medical History Form	DI-4015

ICR Summary of Burden

	Total Request	Previously Approved
Annual Number of Responses	11,409	11,409
Annual Time Burden (Hours)	4,239	4,239
Annual Cost Burden (Dollars)	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: $263,328

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:

Approved RCFs using this ICR

Agency/Sub Agency	RCF ID	RCF Title	RCF Status	IC Title

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