Crisis Corps Supplemental Statement

Peace Corps -- Crisis Corps

Peace Corps Crisis Corps Volunteer Application Form

OMB Approval No. 0420-0533

Supporting Statement Page 1

Section A: Justification

1. This collection of information, entitled the Peace Corps-Crisis Corps Application Form is necessary to recruit qualified Volunteers to serve in the Peace Corps Crisis Corps Program (hereinafter “the application”). The Peace Corps Act (22 U.S.C. 2501 et seq.) authorizes the recruitment of persons for service in the Peace Corps Volunteer programs. See 22 U.S.C. section 2504. Eligibility requirements for Peace Corps Volunteer service are set at 22 C.F.R. section 305. Attached are 22 U.S.C. section 2504 and 22 C.F.R. section 305. The Crisis Corps missions supports the 1^st and 2^nd goal of Peace Corps Act.

2. The information is used by Crisis Corps staff to perform initial screening for potential candidates for specific Crisis Corps assignments. The Peace Corps Crisis Corps Application Form is completed by applicants for Crisis corps assignment to provide basic information concerning technical and language skills, suitability and availability for Crisis Corps assignments. Crisis Corps applicants are returned Peace Corps Volunteers (RPCVs) and currently serving Peace Corps Volunteers (PCVs).

3. The Peace Corps Crisis Corps Application Form is on the Peace Corps website and the Peace Corps intranet site and applicants can download the Application to complete. Roughly 50% of new applications are received via email. We are investigating the possibility of providing applicants with the option of completing the application online, thus reducing the overall burden.

4. The information requested in the Application does not exist in its entirety within the Agency’s records. Agency records concerning Volunteers’ service experiences are kept for a limited period. Even when records are available, Volunteers routinely acquire new skills and languages during service that may not be reflected in Agency records. Former Volunteers may have acquired new skills, degrees or work experience since the end of their Peace Corps service.

5. This collection of information does not impact small business or other small entities.

6. Failure to collect this information would hinder the crisis Corps’ ability to place qualified and available returned Peace Corps Volunteers and Volunteers completing their Peace Corps service in short-term overseas assignments.

7. No special circumstances exist that require the information collection to be conducted n a manner inconsistent with the guidelines in CFR subsection 1320.6

Peace Corps -- Crisis Corps

Peace Corps Crisis Corps Volunteer Application Form

OMB Approval No. 0420-0533

Supporting Statement Page 2

8. The Agency’s notice, required by 5 CFR section 1320.8(d) was published in the Federal Register on April 23, 2003, Volume 68, No. 78 and appeared on page 20035. No public comments were received during this 60-day period. The Agency consulted with returned Peace Corps Volunteers to confirm that this collection of information was necessary and appropriate.

9. No payments or gifts are provided to respondents.

10. Respondents are informed of protections granted pursuant to the Privacy Act and that Peace Corps will only disclose information as outlined on the application form, as stated below:

Privacy Act and Paperwork Reduction Notice

The Peace Corps, an agency of the Federal Government, is required by provisions of the Privacy Act of 1974 (5 U.S.C. 552a) to advise you of the following information regarding this application:

1. This application is authorized by provisions of the Peace Corps Act (22 U.S.C. 2501, et seq.), which authorized the collection of information for the recruitment of persons for service in Peace Corps Volunteer programs.

2. Providing the information herein is voluntary and it will only be used to determine your interest in Peace Corps programs.

3. Information in the application may routinely be disclosed as follows:

   1. To hose country agencies for the purpose of determining placement, obtaining visas, and other program-related matters;

   2. To police or judicial authorities where appropriate;

   3. To the Treasury and other Federal agencies for use in connection with support payments and Federal Income tax maters;

   4. To the office of Personnel Management, other Federal agencies and other, if necessary, for the purpose of a background suitability investigation;

   5. To other Federal agencies having interest in employment of the applicant or Volunteer, provided that except for information required for authorized security clearances, information provided will be limited to dates of service and a standard description;

   6. To a court or other appropriate tribunal upon subpoena or other request;

   7. To a member of Congress upon request indicating that such member has been requested by an individual about whom the records is maintained to obtain such information;

Peace Corps -- Crisis Corps

Peace Corps Crisis Corps Volunteer Application Form

OMB Approval No. 0420-0533

Supporting Statement Page 3

8. To a source for management information or preparation for statistical reports (without personal information);

   1. To the National Archives and Records Administration, GSA, in Authorized management inspections;

   2. To the Bureau of the census for the purposes of planning or carrying out a census survey or related activity pursuant to the provisions of Title 13, U.S. Code;

   3. To Peace Corps personnel who have a need for the information in the performance of their duties;

   4. To the Volunteer’s family members in emergency situations.

9. The Peace Corps estimates that it will take 5 minutes to complete this form. Comments on this form can be sent to: Peace Corps, Paperwork Reduction Project, Attn: NEOB, Washington, DC 20526. Mention OMB approval number 0420-0533.

11. No questions of a sensitive nature are asked.

12. Estimates of hour burden of the collection of information:

a) Annual reporting burden: 42 hours

b) Annual recordkeeping burden: 0 hours

c) Estimated average burden per response: 5 minutes

d) Frequency of response: One time

e) Estimated number of respondents: 507

f) Estimated Cost to respondents: $2.26

12. NA

13. Estimate of annualized cost to the Federal Government:

NA

Peace Corps -- Crisis Corps

Peace Corps Crisis Corps Volunteer Application Form

OMB Approval No. 0420-0533

Supporting Statement Page 4

15. NA

15. Not applicable. The results of this collection of information will not be published.

15. The Agency is seeking to display the words “continuous use form” with the OMB approval number in lieu of the date. In case old versions are still out in distribution, not having been mailed back and beyond our control; we do not want to lose an applicant because of a date. The function of the form is still usable as earlier editions are still correct.

15. Not applicable. There are not exceptions to the certifications statement identified in Item 19, “Certification for Paperwork Reduction Act Submissions” of OMB Form 83-I.

Section B: Collection of Information Employing Statistical Methods

The collection of information does not employ statistical methods.