Form 1 OTIP Fast Track Request

OMB Control No: 0970-0401

Expiration date: 5/31/2018

The Administration for Children and Families within the U.S. Department of Health and Human Services announces an opportunity to advise the Secretary and the Attorney General on practical and general policies concerning improvements to the Nation’s response to the human trafficking of children and youth in the United States. The National Advisory Committee on the Trafficking of Children and Youth in the United States (Advisory Committee) will be composed of not more than 21 members whose diverse experience and background enable them to provide balanced points of view with regard to carrying out the duties of the Committee.

 

The Statement of Interest form below asks for demographic information, experience in anti-trafficking work on a local, state and/or national level; interest in the Committee; and what he/she hopes to contribute to the Committee. Per the Preventing Sex Trafficking and Strengthening Families Act of 2014 (P.L. 113-183), the information will be used to incorporate balanced points of view with regard to carrying out the duties of the Committee. Submission of a Statement of Interest does not mean that a person has been accepted as a Committee member.

Criteria for Selection:

All Committee members must be 18 years or older. In addition, the following criteria will also be considered:

1. Advocacy and victim service experience

2. Respect for diversity of views and human trafficking experiences

3. Interest and ability to provide thoughtful commentary and guidance on federal anti-trafficking initiatives

4. Ability to share lessons learned with survivors, anti-trafficking organizations, and governmental agencies

How to Submit Statements of Interest:

To be considered for participation in the National Advisory Committee on the Trafficking of Children and Youth in the United States, please submit a completed Statement of Interest form through one of the following methods:

Online (preferred): www.acf.hhs.gov/programs/endtrafficking/forms

E-mail: [email protected]

U.S. Mail: The Office on Trafficking in Persons

Administration for Children and Families

U.S. Department of Health and Human Services

Attention: Kate Cooper

330 C Street SW, Room 4126

Washington, DC 20024

STATEMENT OF INTEREST FORM:

Deadline: July 1, 2016 (5:00 pm EST)

First Name:

Last Name:

Title (if any):

Organization/Agency (if any):

Street Address:

City:

Phone:

State/Zip Code:

E-mail:

We are looking for participation that reflects balanced points of view. To help ensure a diversity of background among participants on the Committee, please answer the following questions:

1. Demographic Information

Are you 18 years or older?  Yes  No

Gender: __________________________________

Are you a U.S. citizen?  Yes  No

If not, are you a lawful permanent resident in the U.S.?  Yes  No

Country of Origin: __________________________________

Tribal Affiliation (if any): __________________________________

2. Service System and Sector Experience (check up to three that apply):

 State government

 Local government

 Tribal government

 Child welfare agency

 Social service provider

 Physical health provider

 Mental health provider

 Victim service provider

 Family and juvenile court

 Juvenile justice

 Law Enforcement

 Runaway and homeless youth program

 Schools

 Gaming and entertainment industry

 Youth-serving businesses

3. Professional Experience (check all that apply):

 Policy and legal advocacy

 Direct social service provision

 Research and data

 Capacity building and training

 Executive/senior leadership

 Survivor leadership/advocacy

 Law Enforcement

4. Are you a survivor of human trafficking, as defined by the Trafficking Victims Protection Act of 2000, as amended?  Yes  No

If Yes, type of trafficking:  Sex Trafficking  Labor Trafficking  Both

5. Please describe what you hope to contribute to the Committee (maximum 150 word count):

6. Please describe your involvement in local, state, tribal, or federal anti-trafficking efforts (maximum 100 word count):

7. Is there anything else you would like us to know about yourself? (maximum 50 word count):

Please attach a resume, a bio of no more than 150 words, and up to 2 optional letters of support. If you need more information, contact Kate Cooper at (202) 205-4554 or email [email protected].

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

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