Peace Corps Confidential Reference Form

Forms and Documents

Document Name	Status
Form PC-1532 Peace Corps Confidential Reference Form Form and Instruction	New
Justification_PC Confidential Reference Form_2015.10.15.docx Justification for No Material/Nonsubstantive Change	2015-10-20
Justification_for_changes_to_Confidential_Reference_Form_2014 7 29.docx Justification for No Material/Nonsubstantive Change	2014-07-30
Confidential Reference Supporting Statement_ 08-30-2017.docx Supporting Statement A	2017-08-30
Peace Corps Act.pdf Supplementary Document	2011-02-04

IC Document Collections

IC ID	Document Title	Status
226752	Peace Corps Confidential Reference Form Form and Instruction	New

ICR Details

OMB Control No: 0420-0006	ICR Reference No: 201705-0420-001
Status: Historical Active	Previous ICR Reference No: 201510-0420-003
Agency/Subagency: PEACE	Agency Tracking No: PC-1532
Title: Peace Corps Confidential Reference Form
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: 08/31/2017
	Date Received in OIRA: 05/16/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved	03/31/2018
Responses	18,000	0	40,000
Time Burden (Hours)	3,000	0	6,667
Cost Burden (Dollars)	0	0	0

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Abstract: The reference form is a tool that the Peace Corps employs to ensure a standardized suitability review of applicants. The Assessment and Placement Officer requests the completion of the reference form and uses the information therein to assist in determining the suitability and competitiveness of the applicant. The reference form is an integral part of the selection process to determine whether an applicant is likely to succeed as a Peace Corps volunteer.

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Authorizing Statute(s): US Code: 22 USC 2504 Name of Law: Peace Corps Act
  

Citations for New Statutory Requirements: US Code: 22 USC 2501 et seq Name of Law: Peace Corps Act

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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:
	82 FR 12143	02/28/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 23356	05/15/2017
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
Peace Corps Confidential Reference Form	PC-1532	Peace Corps Confidential Reference Form

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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	18,000	40,000	0	-22,000	0	0
Annual Time Burden (Hours)	3,000	6,667	0	-3,667	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: Yes

Burden Reduction Due to: Using Information Technology

Short Statement: The reference form employs the use of information technology to make the collection of the data electronic, reducing time for references and the use of agency resources. The use of a standardized, automated electronic form improves the quality of the information collected by ensuring that the same information is received from all references. It also ensures the confidentiality of the content, as the reference submits the form directly to the Peace Corps, and not through the applicant.

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Annual Cost to Federal Government: $15,000

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 05/16/2017

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