Information Collection

AmeriCorps Diversity Questionnaire

IC 248995 under ICR 202203-3045-001 · OMB 3045-0193.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 AmeriCorps Diversity Questionnaire	Form
1 AmeriCorps Diversity Questionnaire Diversity_Questionnaire_Collection_FINAL_31March2022.xlsx www.nationalservice.gov	Form
1 AmeriCorps Diversity Questionnaire Diversity_Questionnaire_Collection_FINAL_31March2022.xlsx www.nationalservice.gov	Form

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1	AmeriCorps Diversity Questionnaire	Diversity_Questionnaire_Collection_FINAL_31March2022.xlsx	www.nationalservice.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: 3,350

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
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	3,350	2,600	0	750
Annual IC Time Burden (Hours)	16,750	13,000	3,375	375
Annual IC Cost Burden (Dollars)	0	0	-16,928	16,928

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.