Volunteer Service Agreement Form

ICR 202201-3060-005

OMB: 3060-1298

Federal Form Document

IC Document Collections
251168 New
ICR Details
Received in OIRA
Volunteer Service Agreement Form
Existing collection in use without an OMB Control Number   No
Emergency 01/19/2022
  Requested Previously Approved
6 Months From Approved
25 0
6 0
0 0

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.
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.

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

Not associated with rulemaking


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

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

Warren Firschein 202 418-0844 [email protected]


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:
    (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;
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.

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