Post Service Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form PC-2144 Post-Service Survey	Form	New	Available
Supporting Statement Questions - 122015.docx	Supporting Statement A	Uploaded 2015-12-04	Repair queued
PC-2144 Post-Service Survey.docx	Supplementary Document	Uploaded 2015-12-04	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
219189	Post-Service Survey	Form	New

ICR Details

OMB Control No:	ICR Reference No: 201512-0420-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: PEACE	Agency Tracking No:
Title: Post Service Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 01/08/2016
	Date Received in OIRA: 12/04/2015
Terms of Clearance: Peace Corps may request approval of this information collection when it has included supporting documentation on the statistical methods used.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To assist Returned Peace Corps Volunteers (RPCVs) in obtaining these entitlements, the Peace Corps Office of Health Services (OHS) has created a Post-Service Unit, whose job is to facilitate RPCVs’ application to the FECA program for benefits. Since FECA is operated by a separate federal agency, the Post-Service Unit is critical in ensuring that RPCVs receive appropriate guidance and support in their benefits application. OHS is interested in the satisfaction levels of RPCVs with the services received through the Post-Service Unit. In addition, OHS is interested in the various experiences that RPCVs have with the FECA program so that we can better explain and assist RPCVs through the FECA application process.

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Authorizing Statute(s): US Code: 22 USC 2504(e) Name of Law: null
  

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 54598	09/10/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 73839	11/25/2015
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Post-Service Survey	PC-2144	Post Service Survey

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Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: The Post-Service Survey will be entered electronically into the online Survey Monkey website. We estimate that the average respondent will take approximately 5 minutes to complete the survey (based on a pilot of 10 respondents within the Office of Health Services). There are 60,000 email addresses in the Peace Corps Returned Volunteer email database of Volunteers who have served within the past 20 years (i.e. since 1996). We expect a 15% response rate (12,000 responses).

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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: 12/04/2015

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