Information Collection

2021 Renewal

IC 249441 under ICR 202109-3045-001 · OMB 3045-0035.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0035 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2021 Renewal	Form and Instruction
1 Application Instructions 20210730 AmeriCorps Seniors Grant Application Instructions.docx www.americorps.gov	Form and Instruction
1 Application Instructions 20210730 AmeriCorps Seniors Grant Application Instructions.docx www.americorps.gov	Form and Instruction
2 Progress Report Instructions 20210730 AmeriCorps Seniors PPR Instructions.docx www.americorps.gov	Form and Instruction
2 Progress Report Instructions 20210730 AmeriCorps Seniors PPR Instructions.docx www.americorps.gov	Form and Instruction
3 Independent Living Survey 20210730 AmeriCorps Seniors Independent Living Survey.docx www.americorps.gov	Form and Instruction
3 Independent Living Survey 20210730 AmeriCorps Seniors Independent Living Survey.docx www.americorps.gov	Form and Instruction
4 Respite Survey 20210730 AmeriCorps Seniors Respite Survey.docx www.americorps.gov	Form and Instruction
4 Respite Survey 20210730 AmeriCorps Seniors Respite Survey.docx www.americorps.gov	Form and Instruction
5 Progress Report Supplement 20210730 PRS Revisions Draft.docx www.americorps.gov	Form and Instruction
5 Progress Report Supplement 20210730 PRS Revisions Draft.docx www.americorps.gov	Form and Instruction

IC Title:

2021 Renewal

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	Application Instructions	20210730 AmeriCorps Seniors Grant Application Instructions.docx	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	2	Progress Report Instructions	20210730 AmeriCorps Seniors PPR Instructions.docx	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	3	Independent Living Survey	20210730 AmeriCorps Seniors Independent Living Survey.docx	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	4	Respite Survey	20210730 AmeriCorps Seniors Respite Survey.docx	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	5	Progress Report Supplement	20210730 PRS Revisions Draft.docx	www.americorps.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: 6,250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,250	6,250
Annual IC Time Burden (Hours)	2,625	2,625
Annual IC Cost Burden (Dollars)	118,438	118,438

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.