Volunteer Service Agreement Form

Forms and Documents

Document	Type	Status	Availability
Form FCC Form A-384 Individuals or Households	Form and Instruction	New	Repair queued
Emergency PRA Supporting Statement for Volunteer Service Agreement form v1_final version.docx	Supporting Statement A	Uploaded 2022-01-14	Repair queued
Emergency PRA Approval Cover Letter for Volunteer Service Agreement Form v2 signed.pdf	Supplementary Document	Uploaded 2022-01-14	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
251168	Individuals or Households	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202201-3060-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: FCC	Agency Tracking No: OMD-IO
Title: Volunteer Service Agreement Form
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 01/19/2022
Date Submitted to OIRA: 01/14/2022

	Requested	Previously Approved
Expiration Date	6 Months From Approved
Responses	25	0
Time Burden (Hours)	6	0
Cost Burden (Dollars)	0	0

---

Abstract: The Volunteer Service Agreement Form is currently used by the FCC to identify individuals seeking to participate in a volunteer service program administered by the agency and determine their eligibility for such service. In addition, the form is being revised to now require individuals seeking volunteer positions to certify that they comply with COVID-19 vaccine requirements for Federal workers as set forth by Executive Order 14043 and other mandates.

Emergency Justfication: The Federal Communications Commission (Commission or FCC) requests Office of Management and Budget (OMB) approval to submit the information collection described herein under the “emergency processing” provisions of the Paperwork Reduction Act (PRA) of 1995, 5 CFR 1320.13. The Commission is requesting clearance for a new information collection entitled [3060-XXXX], Volunteer Service Agreement, FCC Form A-384. For the reasons explained below, We respectfully request OMB approval for this new information collection at the earliest possible time. To ensure compliance with this mandate, the FCC is requiring all employees to complete and submit a form attesting to their current vaccination status. For volunteer workers, the FCC is choosing to require applicants to certify as to their vaccination status when applying for a position as part of the agency’s existing Volunteer Service Agreement form. However, the FCC is required to obtain OMB approval prior to collecting such information. Moreover, the FCC recently discovered that although its Volunteer Service Agreement form has been used to collect basic identifying information about volunteer applicants for approximately a decade, PRA approval was never sought for the use of this form. Emergency processing is being sought so that the FCC can continue to process volunteer service requests while it seeks approval for use of the existing portion of the form without a lengthy disruption.

---

Authorizing Statute(s): EO: EO 14043 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
   US Code: 5 USC 3111 Name of Law: Acceptance of Volunteer 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

Did the Agency receive public comments on this ICR? No

---

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

IC Title	Form No.	Form Name
Individuals or Households	FCC Form A-384	Volunteer Service Agreement

---

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	25	0	0	25	0	0
Annual Time Burden (Hours)	6	0	0	6	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: This is a new information collection resulting in a program change/increase of 25 respondents, 25 responses, and 6 total estimated burden hours.

---

Annual Cost to Federal Government: $0

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.     Yes

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.     Yes

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: 01/14/2022

---