AmeriCorps Member Application

ICR 201212-3045-001

OMB: 3045-0054

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2012-12-07
Supplementary Document
2012-12-07
Supporting Statement A
2012-12-07
Justification for No Material/Nonsubstantive Change
2011-01-24
IC Document Collections
IC ID
Document
Title
Status
29268 Modified
ICR Details
3045-0054 201212-3045-001
Historical Active 201204-3045-002
CNCS
AmeriCorps Member Application
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 12/07/2012
Retrieve Notice of Action (NOA) 12/07/2012
  Inventory as of this Action Requested Previously Approved
07/31/2015 07/31/2015 07/31/2015
225,000 0 225,000
337,500 0 337,500
0 0 0

The Corporation is seeking approval of the attached AmeriCorps Member Application. This ICR will enable the public to apply to be AmeriCorps members. The following sentence has been added to the Public Burden and Privacy Statement: The information may be shared with other agencies, such as the Social Security Administration, through computer matching agreements for the purpose of verifying identity and citizenship status information provided by you in your application.

US Code: 42 USC 12501 et seq Name of Law: National and Community Service
  
None

Not associated with rulemaking

  77 FR 5496 02/03/2012
77 FR 24479 04/24/2012
No

1
IC Title Form No. Form Name
AmeriCorps Member Application 2011-1, SEC -618, 3 Americorps Member Application ,   2011 Member Application ,   AmeriCorps Member Application 12.7.12

  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 225,000 225,000 0 0 0 0
Annual Time Burden (Hours) 337,500 337,500 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$0
No
Yes
No
No
No
Uncollected
Amy Borgstrom 202 606-6930 [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.
12/07/2012


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