Corporation for National Service, Enrollment and Exit Forms

Forms and Documents

Document Name	Status
Form 1 Corporation for National Service, Enrollment Form Form and Instruction	Modified
Justification for Request for Nonsubstantive Change in AmeriCorps Enrollment and Exit Forms 3045.docx Justification for No Material/Nonsubstantive Change	2017-12-13
2013 Enrollment Exit forms Justification_012414.doc Supporting Statement A	2014-04-10

IC Document Collections

IC ID	Document Title	Status
29199	Corporation for National Service, Enrollment Form Form and Instruction	Modified

ICR Details

OMB Control No: 3045-0006	ICR Reference No: 201712-3045-001
Status: Historical Active	Previous ICR Reference No: 201706-3045-002
Agency/Subagency: CNCS	Agency Tracking No:
Title: Corporation for National Service, Enrollment and Exit Forms
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/15/2017
	Date Received in OIRA: 12/13/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	08/31/2020	08/31/2020
Responses	160,000	0	160,000
Time Burden (Hours)	26,667	0	26,667
Cost Burden (Dollars)	0	0	0

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Abstract: The Corporation for National Service Enrollment form is the means by which information is collected on individuals who enroll and exit for a term of national service in an AmeriCorps or Learn and Serve America Summer of Service program. The form "reserves" an education award for the AmeriCorps member and collects demographic information that is entered into the Corporation's database. This revision changes the burden on the information collection request based on actual use of the forms.

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Authorizing Statute(s): US Code: 42 USC 12501 Name of Law: National and Community Service Act
   US Code: 42 USC 12594-12602 Name of Law: National and Community Service Act
   US Code: 42 USC 12639 Name of Law: National and Community Service Act
   PL: Pub.L. 103 - 82 All Name of Law: National and Community Service Trust 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 15047	03/24/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 26672	06/08/2017
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
Corporation for National Service, Enrollment Form	2, 1	2014 AC Enrollment Form ,   2014 AC Exit 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	160,000	160,000	0	0	0	0
Annual Time Burden (Hours)	26,667	26,667	0	0	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: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

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: 12/13/2017

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