AmeriCorps Member Feedback Survey

Forms and Documents

Document Name	Status
Form 1 AmeriCorps Exit Survey Form and Instruction	Modified
20210330 ORE Member Exit Survey Justification Part B.2.docx Supporting Statement B	2021-04-05
20210405 Member Exit Survey SSA.docx Supporting Statement A	2021-04-05

IC Document Collections

IC ID	Document Title	Status
214239	AmeriCorps Exit Survey Form and Instruction	Modified

ICR Details

OMB Control No: 3045-0094	ICR Reference No: 202104-3045-001
Status: Received in OIRA	Previous ICR Reference No: 201801-3045-001
Agency/Subagency: CNCS	Agency Tracking No:
Title: AmeriCorps Member Feedback Survey
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 04/05/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	80,000	0
Time Burden (Hours)	20,000	0
Cost Burden (Dollars)	0	0

---

Abstract: The primary purpose of the AmeriCorps' Member Feedback Survey is to provide reliable and valid outcome data on members' AmeriCorps experience. As part of this effort, all exiting AmeriCorps members are surveyed regarding their service experience with AmeriCorps State and National, AmeriCorps VISTA, and the AmeriCorps National Civilian Community Corps' (NCCC). Information captured in these surveys helps inform policy decisions and the management of AmeriCorps' National Service Programs, as well as help guide the development of the support provided to members and national service organizations

---

Authorizing Statute(s): US Code: 42 USC 12501 Name of Law: NAtional and Community Service
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 74996	11/24/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 17590	04/05/2021
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
AmeriCorps Exit Survey	1	AmeriCorps Exit Survey

---

ICR Summary of Burden

	Total Request	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	80,000	0	0	0	0	80,000
Annual Time Burden (Hours)	20,000	0	0	0	0	20,000
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:

---

Annual Cost to Federal Government: $11,500

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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.     No

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.     No

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? No

---

Common Form ICR:  No

---

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: 04/05/2021

---