Peace Corps Questionnaire for Peace Corps Volunteer Background Investigations Form

Forms and Documents

Document Name	Status
Form PC-0005 Peace Corps Questionnaire for Peace Corps Volunteer Background Investigations Form Form and Instruction	Modified
Supporting Statement-Questionnaire for PCV Background Investigation.docx Supporting Statement A	2017-09-12
Justification for changes to Peace Corps Volunteer Background Investigation Form_2015.9.24.docx Justification for No Material/Nonsubstantive Change	2015-09-24

IC Document Collections

IC ID	Document Title	Status
900	Peace Corps Questionnaire for Peace Corps Volunteer Background Investigations Form Form and Instruction	Modified

ICR Details

OMB Control No: 0420-0001	ICR Reference No: 201707-0420-001
Status: Historical Active	Previous ICR Reference No: 201509-0420-001
Agency/Subagency: PEACE	Agency Tracking No: PC-0005
Title: Peace Corps Questionnaire for Peace Corps Volunteer Background Investigations Form
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/19/2017
	Date Received in OIRA: 09/12/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2020	36 Months From Approved
Responses	5,000	0	0
Time Burden (Hours)	167	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Volunteer Recruitment and Selection at the Peace Corps utilizes the Questionnaire for Peace Corps Volunteer Background Investigation form (BI form), formerly known as the National Agency Check Questionnaire for Peace Corps Background Investigation Form, as authorization from the invited Peace Corps Volunteer candidate to conduct a background check through the Office of Personnel Management (OPM) or other contract background investigator of pertinent records pertaining to applicants' interaction with the judicial system, qualifications, eligibility and suitability for Peace Corps volunteer service, as well as information relating to whether a Peace Corps assignment is consistent with the national interest, as required by the Peace Corps Act (22 USC §2519.) 22 CFR Part 305 sets out the eligibility and selection standards for Peace Corps service.

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Authorizing Statute(s): US Code: 22 USC 2519 Name of Law: Peace Corps Act
  

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:
	82 FR 21836	05/10/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 39918	08/22/2017
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 Questionnaire for Peace Corps Volunteer Background Investigations Form	PC-0005	Peace Corps Questionaire for Peace Corps Volunteer Background Investigation

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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	5,000	0	0	500	0	4,500
Annual Time Burden (Hours)	167	0	0	-208	0	375
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: a. The agency no longer incurs printing or mailing costs associated with the form. b. The agency has reduced the burden on Federal Employees by eliminating the number of staff that reviews the form. c. The agency maintains an electronic system through which the form collects the information.

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Annual Cost to Federal Government: $1,200

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: 09/12/2017

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