Senior Corps Grant Application

Forms and Documents

Document Name	Status
Form 1 2021 Renewal Form and Instruction	New
Form 1 AmeriCorps Seniors Alternative Service Plan Reporting Form and Instruction	Unchanged
Form 1 Senior Corps Application Form and Instruction	Unchanged
DVSA 5056.pdf Supplementary Document	2021-09-22
Emergency Memo 3.10.21.pdf Supplementary Document	2021-03-15
OMB Change Request Form_9_10_15 Final.pdf Justification for No Material/Nonsubstantive Change	2015-09-10
20210922 AC Seniors Applications SSA.docx Supporting Statement A	2021-09-22

IC Document Collections

IC ID	Document Title	Status
249441	2021 Renewal Form and Instruction	New
246250	AmeriCorps Seniors Alternative Service Plan Reporting Form and Instruction	Unchanged
203497	Senior Corps Application Form and Instruction	Unchanged

ICR Details

OMB Control No: 3045-0035	ICR Reference No: 202109-3045-001
Status: Received in OIRA	Previous ICR Reference No: 202104-3045-002
Agency/Subagency: CNCS	Agency Tracking No:
Title: Senior Corps Grant Application
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 09/22/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved	10/31/2021
Responses	11,900	5,650
Time Burden (Hours)	22,645	20,020
Cost Burden (Dollars)	118,438	0

---

Abstract: The Corporation for National and Community Service (CNCS) doing business as AmeriCorps, is submitting a regular renewal of this information collection which includes the application, progress report, and survey instruments related to the AmeriCorps Seniors program.

---

Authorizing Statute(s): PL: Pub.L. 106 - 170 5011 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
   PL: Pub.L. 106 - 170 5013 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
   PL: Pub.L. 106 - 170 5082 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
   PL: Pub.L. 106 - 170 5001 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
  

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:
	86 FR 32249	06/17/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 52448	09/21/2021
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
2021 Renewal	1, 2, 3, 4, 5	Application Instructions ,   Progress Report Instructions ,   Independent Living Survey ,   Respite Survey ,   Progress Report Supplement
AmeriCorps Seniors Alternative Service Plan Reporting	1	AmeriCorps Senior Alt Service Reporting Questions
Senior Corps Application	2, 2, 1, 3, 4, 5, 6, 1, 2, 1	SC Application Instructions Volume 1 ,   SC Application Instructions Volume 2 ,   Work Plan Worksheet FGP ,   Workplan Worksheet RSVP ,   Workplan Worksheet SCP ,   Sc Station Roster ,   2016 FGP-SCP Grant Application Instructions ,   2016 RSVP Grant Application Instructions ,   2016 FGP-SCP Grant Application Instructions Revised ,   2016 RSVP Application Instructions Revised

---

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	11,900	5,650	0	6,250	0	0
Annual Time Burden (Hours)	22,645	20,020	0	2,625	0	0
Annual Cost Burden (Dollars)	118,438	0	0	118,438	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The cost burden has increased because the agency was not required to complete it in the last submission. The slight increase in burden is due to additional questions in the Progress Report Supplement to collect additional demographic information on both volunteers and client/participants served.

---

Annual Cost to Federal Government: $70,531

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.     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? Yes

---

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: 09/22/2021

---