Corporation for National Service, Enrollment and Exit Forms

Forms and Documents

Document Name	Status
Form 2 Corporation for National Service, Enrollment Form Form and Instruction	Modified
10 Enrollment Exit form-OMB Justification091710.doc Supporting Statement A	2010-09-21

IC Document Collections

IC ID	Document Title	Status
29199	Corporation for National Service, Enrollment Form Form and Instruction	Modified

ICR Details

OMB Control No: 3045-0006	ICR Reference No: 201006-3045-002
Status: Historical Active	Previous ICR Reference No: 200704-3045-004
Agency/Subagency: CNCS	Agency Tracking No:
Title: Corporation for National Service, Enrollment and Exit Forms
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/21/2010
	Date Received in OIRA: 07/22/2010
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved	09/30/2010
Responses	296,000	0	146,000
Time Burden (Hours)	49,333	0	8,517
Cost Burden (Dollars)	0	0	0

---

Abstract: The Corporation for National Service Enrollment form is the means by which information is collected on individuals who enroll and exit for a term of national service in an AmeriCorps or Learn and Serve America Summer of Service program. The form "reserves" an education award for the AmeriCorps member and collects demographic information that is entered into the Corporation's database.

---

Authorizing Statute(s): US Code: 42 USC 12501 Name of Law: National and Community Service Act
   US Code: 42 USC 12594-12602 Name of Law: National and Community Service Act
   US Code: 42 USC 12639 Name of Law: National and Community Service Act
   PL: Pub.L. 103 - 82 All Name of Law: National and Community Service Trust Act
  

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:
	75 FR 19376	04/14/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 42430	07/21/2010
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Corporation for National Service, Enrollment Form	3, 4, 2	2010 Summer of Service Enrollment and Exit ,   2010 AC Exit Form ,   2010 AC Enrollment Form

---

ICR Summary of Burden

	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	296,000	146,000	0	150,000	0	0
Annual Time Burden (Hours)	49,333	8,517	0	40,816	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Changing Regulations

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is an increase of burden due to the inclusion of two new instruments for enrollment, exit, and certification of Summer of Service participants, a new program authorized by the Serve America Act.

---

Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 07/22/2010

---