GHSP Professional Reference Form

ICR 201705-0420-003

OMB: 0420-0562

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Supporting Statement A
2017-05-16
IC Document Collections
IC ID
Document
Title
Status
226755 New
ICR Details
0420-0562 201705-0420-003
Historical Active
PEACE PC-2172
GHSP Professional Reference Form
New collection (Request for a new OMB Control Number)   No
Regular
Approved without change 08/01/2017
Retrieve Notice of Action (NOA) 05/16/2017
  Inventory as of this Action Requested Previously Approved
08/31/2020 36 Months From Approved
240 0 0
40 0 0
0 0 0

The information collected in the reference forms is an integral part of the screening and selection process and is used to determine whether an applicant would be a good candidate as a Global Health Service Partnership Volunteer. The information obtained from these forms is used by the recruitment and placement specialist within the Office of Peace Corps Response. There is no other means of obtaining the required data, and the information gathered is not shared with outside sources or other government agencies.

US Code: 22 USC 305 Name of Law: Peace Corps Law
  
None

Not associated with rulemaking

  82 FR 12858 03/07/2017
82 FR 22356 05/15/2017
No

1
IC Title Form No. Form Name
GHSP Professional Reference Form PC-2172 GHSP Professional 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 240 0 0 240 0 0
Annual Time Burden (Hours) 40 0 0 40 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
The burden increased due to agency discretion.

$499
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.
05/16/2017


© 2024 OMB.report | Privacy Policy