AmeriCorps Member Application

Forms and Documents

Document Name	Status
Form 4 AmeriCorps Member Application Form and Instruction	Modified
Justification for Non-Substantive Change 12.7.12.docx Justification for No Material/Nonsubstantive Change	2012-12-07
List of Revisions AC Member App 12.6.12.docx Supplementary Document	2012-12-07
AC Member Application Justification Final.doc Supporting Statement A	2015-10-02
Justification for Change in AmeriCorps Member Application 1.13.11.doc Justification for No Material/Nonsubstantive Change	2011-01-24

IC Document Collections

IC ID	Document Title	Status
29268	AmeriCorps Member Application Form and Instruction	Modified

ICR Details

OMB Control No: 3045-0054	ICR Reference No: 201510-3045-001
Status: Historical Active	Previous ICR Reference No: 201212-3045-001
Agency/Subagency: CNCS	Agency Tracking No:
Title: AmeriCorps Member Application
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/17/2015
	Date Received in OIRA: 10/02/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	36 Months From Approved
Responses	225,000	0	0
Time Burden (Hours)	281,250	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: 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.

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Authorizing Statute(s): US Code: 42 USC 12501 et seq Name of Law: National and Community Service
  

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:
	80 FR 28245	05/18/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 59139	10/01/2015
Did the Agency receive public comments on this ICR? No

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

IC Title	Form No.	Form Name
AmeriCorps Member Application	2011-1, SEC -618, 3, 4	2015 AmeriCorps Member Application ,   Americorps Member Application ,   2011 Member Application ,   AmeriCorps Member Application 12.7.12

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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	225,000	0	0	0	0	225,000
Annual Time Burden (Hours)	281,250	0	0	-56,250	0	337,500
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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The burden has decreased based on actual experience.

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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? 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: 10/02/2015

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