AMERICORPS MEMBER APPLICATION FORM FOR FEDERAL AGENCIES

ICR 199407-3045-003

OMB: 3045-0016

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
149226
Migrated
ICR Details
3045-0016 199407-3045-003
Historical Active
CNCS
AMERICORPS MEMBER APPLICATION FORM FOR FEDERAL AGENCIES
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 07/29/1994
Retrieve Notice of Action (NOA) 07/25/1994
CNCS' Americorps application form for Federal agencies is approved with the following changes, agreed to by CNCS. 1) CNCS has developed Privacy Act statement to explain why the agency is requiring provision of a SSN. 2) CNCS has re-written race/ethnicity categories to comply with OMB Directive 15. 3) CNCS will allow race/ethnicity data to be submitted separately and anonymously. 4) CNCS has amended the educational background checklist to state that only the highest level education attained should be checked.
  Inventory as of this Action Requested Previously Approved
07/31/1997 07/31/1997
5,000 0 0
3,750 0 0
0 0 0

FEDERAL AGENCIES THAT OPERATE AMERICORPS PROGRAMS WILL NEED THIS FORM SELECT THEIR MEMBERS. FEDERAL AGENCIES WILL USE THIS FORM TO SELECT AMERICORPS MEMBERS. AFFECTED PUBLIC IS POTENTIAL AMERICORPS MEMBERS A FEDERAL AGENCIES.

None
None


No

1
IC Title Form No. Form Name
AMERICORPS MEMBER APPLICATION FORM FOR FEDERAL AGENCIES

  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 5,000 0 0 5,000 0 0
Annual Time Burden (Hours) 3,750 0 0 3,750 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
07/25/1994


© 2024 OMB.report | Privacy Policy