Information Collection

Segal Education Award Matching Program Commitment Form

IC 202529 under ICR 201807-3045-001 · OMB 3045-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0143 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Segal Education Award Matching Program Commitment Form	Form and Instruction
1 Ed Award Commitment Matching Form Segal Award Matching Program Commitment Form_V6 5.docx www.nationalservice.gov	Form and Instruction

IC Title:

Segal Education Award Matching Program Commitment Form

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Ed Award Commitment Matching Form	Segal Award Matching Program Commitment Form_V6 5.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: 200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.