Peace Corps
Office of Peace Corps Response
OMB Control Number 0420-XXXX
Supporting Statement-GHSP Professional and PC Staff Reference Form
General instructions
The supporting statement must be prepared in the format described below. If an item in applicable, use “N/A” and provide a brief explanation.
Section A: Justification
Circumstances that make the collection of information necessary.
Peace Corps Response uses the staff, personal and professional reference forms to learn from someone who knows the applicant and his or her background whether the applicant possesses the necessary characteristics and skills to serve as a Global Health Service Partnership Volunteer. Eligibility requirements for Peace Corps Volunteer service are set at 22 C.F.R. 305; attached.
By whom, how, and for what purpose the information is to be used.
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.
Consideration of the use of improved information technology.
Peace Corps Response collects reference forms electronically. Qualified applicants, following the submission of their application and only if contacted for an interview, will be required to submit reference contact information, which is saved electronically to the applicant’s Peace Corps record. Peace Corps Response staff sends reference forms to references electronically. References complete and submit the forms electronically, unless they prefer to answer the questions over the phone. In this case, the Peace Corps Response staff person enters the responses into the electronic form.
Efforts to identify duplication. Why similar information cannot be used.
Information from an applicant’s references is not available elsewhere. If a candidate reapplies to serve as a Global Health Service Partnership Volunteer, Peace Corps Response will use existing contact information unless the applicant wishes to provide updated information.
5. Methods to minimize the burden to small business if involved.
This collection of information does not impact small business or other small entities.
Consequences to the Federal program if collection were conducted less frequently.
If Peace Corps Response were unable to collect the reference information, the program would be unable to adequately assess applicants for qualifications and suitability. An inadequately screened Global Health Service Partnership Volunteer may have poor performance or bad judgment or lack qualifications. Global Health Service Partnership Volunteers are representatives of the United States. Volunteers who perform poorly or engage in unsatisfactory conduct reflect negatively on the Peace Corps and the United States, and may create conflict and embarrassment for the Peace Corps and the United States by attracting negative media or political attention and even more importantly potentially diminish the safety and protection of all of our Volunteers, and the communities and institutions they serve.
7. Explain any special circumstances that would cause the information collection to be conducted in a manner inconsistent with guidelines.
No special circumstances exist that require the information collection to be conducted in a manner inconsistent with the guidelines in 5 CFR 1320.6.
8. Consultation.
The FOIA Officer will provide the Federal Register information.
9. Explain any decision to provide any payment or gift to respondents.
No payments or gifts are provided to respondents.
10. Describe any assurance of confidentiality provided to respondents.
Privacy protections are provided in the Privacy Act notice in the reference forms. It reads:
Confidentiality Statement
The Privacy Act is a federal law that states that everyone has the right to know about and receive information about, or copies of, documents about them that are maintained by the federal government. This law provides that the Peace Corps may keep the identity of the source of this reference confidential only if you request that it be kept confidential. Please indicate below whether you do or do not wish your identity revealed to the applicant.
I AUTHORIZE the Peace Corps to identify me as the source of this reference and to release a copy of this reference, upon request, to the applicant.
I DO NOT authorize the Peace Corps to identify me as the source of this reference, nor do I authorize the Peace Corps to release a copy of this reference to the applicant. I realize that a summary of this reference may be released without my authority.
Privacy Act Statement: Section 2504 of Title 22, United States Code, authorizes collection of this information. The primary use of this information, the provision of which is voluntary, is to determine whether applicants for Peace Corps Volunteer service are qualified and suitable. Without such information, the Peace Corps may be unable to determine the applicant’s qualifications and suitability for Peace Corps service. To the extent permitted under the Privacy Act of 1974, 5 U.S. C. 552a(k)(5), this system has been exempted from the provisions of the Privacy Act of 1974 that permit access and correction. The exemption from access is limited in some instances by law to information that would reveal the identity of a confidential source. See 65 FR 53772, pp. 53783–84 (September 5, 2000); 50 FR 1950, 1962 (January 14, 1985); and Peace Corps regulations at 22 CFR 308.14(c).
11. Additional justification for any questions of a sensitive nature.
In the reference forms, the reference is asked the following question pertaining to the Peace Corps applicant: “Do you know of any reasons why this individual should not work with children?” The information obtained from the answer to this question will be part of the Peace Corps’ assessment of the applicant’s suitability to serve as a Peace Corps Volunteer.
The Agency considers this question necessary because Peace Corps Volunteers represent the United States and the American people in the countries and communities where they serve overseas. The Peace Corps expects Volunteers to conduct themselves at all times in a manner reflecting credit on the Peace Corps and the United States. Appropriate Volunteer conduct is critical because it is intimately tied not only to the reputation and effectiveness of the Peace Corps program, but even more importantly to the safety and protection of our Volunteers, and the communities and children they serve.
The explanation to be given to those from whom the information is requested will be the following: “Peace Corps Response Volunteers represent the United States and the American people in the countries and communities where they serve abroad. The Peace Corps expects Volunteers to conduct themselves at all times in a manner reflecting positively on the Peace Corps and the United States. Appropriate Volunteer conduct is critical because it is intimately tied to the safety and protection of Volunteers, and that of the communities and children they serve, as well as the reputation and effectiveness of Peace Corps programs. Please consider these factors carefully when completing this recommendation. Please include any information that may inform our assessment of the applicant’s suitability to serve as a Peace Corps Response Volunteer.”
12. Estimates of reporting and recordkeeping hour and cost burdens of the collection of information.
Number of interviewed applicants:* 120
Number of references required per interviewed applicant:** 2
Estimated number of reference forms received: 240
Frequency of response: One time
Completion time: 10 minutes
Annual burden hours: 40
*Reference information is collected only if an applicant is contacted for an interview.
The estimated number of applicants interviewed is 120 based on the first three years of the GHSP program.
13. Estimates of annualized capital and start-up costs.
Cost estimate to the respondent: $0.00
14. Estimates of annualized Federal Government costs.
Total annual cost to the Federal government per annum: $499
Number of reference forms reviewed: 120
Amount of time spent reviewing reference forms: 20 hours
10 minutes per form x 120 forms /60 minutes
Labor cost: $499
20 hours/ 2087 hours per year = 0.07% of Recruitment and Placement Specialists’ time;
0.07% of Recruiters’ salary * $71,246 Recruitment and Placement Specialist annual salary
15. Explanation of change in burden.
No changes.
16. Information collections data planned to be published for statistical use.
The results of this collection of information will not be published.
17. Explanation for seeking not to display the expiration date for OMB approval of the information collection.
The Agency is not seeking approval to conceal or omit the expiration date for OMB approval of the information collection.
18. Exception to the certification statement.
The agency is able to certify compliance with all provisions under Item 19 of OMB Form 83-I.
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | Peace Corps – Office of Volunteer Recruitment and Selection |
| Author | nfull |
| File Modified | 0000-00-00 |
| File Created | 2021-01-22 |