Affidavit Declaring Domestic Partner Relationship

ICR 201004-0420-001

OMB: 0420-0554

Federal Form Document

Forms and Documents
IC Document Collections
ICR Details
0420-0554 201004-0420-001
Historical Active
PEACE 30111-1
Affidavit Declaring Domestic Partner Relationship
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 01/09/2014
Retrieve Notice of Action (NOA) 09/05/2013
  Inventory as of this Action Requested Previously Approved
01/31/2017 36 Months From Approved
325 0 0
11 0 0
0 0 0

This Affidavit seeks information necessary for the Peace Corps' Office of Volunteer Recruitment and Selection to verify that a domestic partner couple applying to be accepted and placed together as Peace Corps Volunteers meet accepted criteria for placement as a couple.

None
None

Not associated with rulemaking

  78 FR 36794 06/19/2013
78 FR 53173 08/28/2013
Yes

1
IC Title Form No. Form Name
Affidavit Declaring Domestic Partner Relationship PC-2109 Affidavit Declaring Domestic Partner Relationship

  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 325 0 0 325 0 0
Annual Time Burden (Hours) 11 0 0 11 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new information collection.

$733
No
No
No
No
No
Uncollected
Ana Cardoso 202 692-1250 [email protected]

  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.
09/05/2013


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