Peace Corps National Agency Check (NAC) Questionnaire Form for Peace Corps Volunteer Background Investigations

Forms and Documents

Document Name	Status
Form PC Form 0005 Peace Corps National Agency Check (NAC) Questionnaire Form for Peace Corps Volunteer Background Investigations Form and Instruction	Modified
0420-0001 Supporting Statement (03092012).docx Supporting Statement A	2012-03-14

IC Document Collections

IC ID	Document Title	Status
900	Peace Corps National Agency Check (NAC) Questionnaire Form for Peace Corps Volunteer Background Investigations Form and Instruction	Modified

ICR Details

OMB Control No: 0420-0001	ICR Reference No: 201108-0420-005
Status: Historical Active	Previous ICR Reference No: 201105-0420-001
Agency/Subagency: PEACE	Agency Tracking No:
Title: Peace Corps National Agency Check (NAC) Questionnaire Form for Peace Corps Volunteer Background Investigations
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: 04/12/2012
	Date Received in OIRA: 08/30/2011
Terms of Clearance: This collection is approved for two years due to a failure to fully comply with GPEA.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	36 Months From Approved	04/30/2012
Responses	13,500	0	13,500
Time Burden (Hours)	3,375	0	3,375
Cost Burden (Dollars)	0	0	0

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Abstract: The Peace Corps Act requires a NAC background investigation of all Volunteers to ensure suitability consistent with the national interests established by the President for standards and procedures fulfilling the statutory requirements. The NAC background check form is used to screen Peace Corps applicants for legal and criminal history. The information obtained on the form is provided to the Office of Personnel Management to obtain the necessary information as to an applicant's suitability for service. All applicants who complete the initial Peace Corps Application Form are sent a "legal kit" to complete, which includes this form among others related to the applicants' suitability.

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Authorizing Statute(s): US Code: 22 USC 2519 Name of Law: Peace Corps Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 12939	05/25/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 20931	08/16/2011
Did the Agency receive public comments on this ICR? Yes

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

IC Title	Form No.	Form Name
Peace Corps National Agency Check (NAC) Questionnaire Form for Peace Corps Volunteer Background Investigations	0005, PC Form 0005	Peace Corps National Agency Check (NAC) Questionnaire for Peace Corps

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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	13,500	13,500	0	0	0	0
Annual Time Burden (Hours)	3,375	3,375	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $56,284

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? No

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]? No

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

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 08/30/2011

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