Peace Corps Confidential Reference Form

ICR 201510-0420-003

OMB: 0420-0006

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2015-10-20
Justification for No Material/Nonsubstantive Change
2014-07-30
Supporting Statement A
2014-12-29
Supplementary Document
2011-02-04
IC Document Collections
IC ID
Document
Title
Status
909 Modified
ICR Details
0420-0006 201510-0420-003
Historical Active 201412-0420-002
PEACE
Peace Corps Confidential Reference Form
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 10/20/2015
Retrieve Notice of Action (NOA) 10/20/2015
  Inventory as of this Action Requested Previously Approved
03/31/2018 03/31/2018 03/31/2018
40,000 0 40,000
6,667 0 6,667
0 0 0

Data collected by the Peace Corps Confidential Reference Form is required to assess and place candidates in Peace Corps Volunteer assignments. Peace Corps has no other means of obtaining the qualifying data.

US Code: 22 USC 2501 Name of Law: Peace Corps Act
  
None

Not associated with rulemaking

  79 FR 61671 10/14/2014
79 FR 77537 12/24/2014
No

1
IC Title Form No. Form Name
Peace Corps Reference Form PC-1532 Peace Corps Confidential Reference Form

  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 40,000 40,000 0 0 0 0
Annual Time Burden (Hours) 6,667 6,667 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$171,580
No
No
No
No
No
Uncollected
Denora Miller 202 692-1236 [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.
10/20/2015


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