AmeriCorps Exit Survey

AmeriCorps Member Feedback Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0094 can be found here:

Documents and Forms

Document Name Document Type
Form 1 AmeriCorps Exit Survey Form and Instruction
1 AmeriCorps Exit Survey Exit Survey_12 01 14.docx www.nationalservice.gov Form and Instruction

Information Collection (IC) Details

IC Title:	AmeriCorps Exit Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	AmeriCorps Exit Survey	Exit Survey_12 01 14.docx	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	80,000	80,000
Annual IC Time Burden (Hours)	20,000	20,000
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.