Information Collection

AmeriCorps Member Application, Enrollment, and Exit Form

IC 251499 under ICR 202202-3045-001 · OMB 3045-0054.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0054 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 AmeriCorps Member Application, Enrollment, and Exit Form	Form and Instruction
1 AmeriCorps Member Application 20220126 AmeriCorps Member Application.docx www.americorps.gov	Form and Instruction
1 AmeriCorps Member Application AmeriCorps Member Application_CLEAN.docx www.americorps.gov	Form and Instruction
2 AmeriCorps Enrollment and Exit Form 20220126 AmeriCorps Enrollment and Exit Forms.docx www.americorps.gov	Form
2 AmeriCorps Enrollment and Exit Form 20220126 AmeriCorps Enrollment and Exit Forms.docx www.americorps.gov	Form

IC Title:

AmeriCorps Member Application, Enrollment, and Exit Form

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	AmeriCorps Member Application	AmeriCorps Member Application_CLEAN.docx	www.americorps.gov	Yes	Yes	Fillable Fileable
Form	2	AmeriCorps Enrollment and Exit Form	20220126 AmeriCorps Enrollment and Exit Forms.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: AmeriCorps-04-CPO-MMF-Member Management Files (MMF)

FR Citation: 85 FR 3896

Number of Respondents: 521,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	521,000	521,000
Annual IC Time Burden (Hours)	390,750	390,750
Annual IC Cost Burden (Dollars)	12,946,850	12,946,850

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.