AmeriCorps Exit Form Non-bias Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0137 can be found here:

Documents and Forms

Document Name Document Type
Form 1 AmeriCorps Exit Form Non-bias Survey Form and Instruction
1 AmeriCorps Non-response Bias Survey AC MES NonResponse Bias Questionnaire_12 27 13.pdf www.nationalservice.gov Form and Instruction
Generic Clearance Submission_AC Member Exit Survey Non-Response Bias.docx Fast Track Justification AC Non-response Bias Survey IC Document

Information Collection (IC) Details

IC Title:	AmeriCorps Exit Form Non-bias Survey	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	AmeriCorps Non-response Bias Survey	AC MES NonResponse Bias Questionnaire_12 27 13.pdf	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,000	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,000	2,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Justification AC Non-response Bias Survey	Generic Clearance Submission_AC Member Exit Survey Non-Response Bias.docx	12/27/2013

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.