Office of Gifts and Grants Management Donation Form

Forms and Documents

Document	Type	Status	Availability
Form PC-2143B Mail-in or Phone-In Donation Form	Form	Modified	Repair queued
Form PC-2143 C Call-in Donation Form	Form	Removed	Repair queued
Form PC-2143 A Online Donation Form	Form	Modified	Repair queued
Supporting Statement 0420-0564 PC-2143 Donation GGM 2022.pdf	Supporting Statement A	Uploaded 2022-06-05	Missing upstream
0420-0564 Authority 22 USC Ch 34 Sec 2509 (a)(4).PNG	Supplementary Document	Uploaded 2022-06-05	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
226964	Mail-in or Phone-In Donation Form	Form	Modified
226963	Call-in Donation Form	Form	Removed
226962	Online Donation Form	Form	Modified

ICR Details

OMB Control No: 0420-0564	ICR Reference No: 202205-0420-002
Status: Received in OIRA	Previous ICR Reference No: 201706-0420-003
Agency/Subagency: PEACE	Agency Tracking No: PC-2143
Title: Office of Gifts and Grants Management Donation Form
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 06/05/2022

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	900	0
Time Burden (Hours)	150	0
Cost Burden (Dollars)	0	0

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Abstract: Peace Corps’ Office of Gifts and Grants Management (GGM) uses the information to process and manage all private sector financial donations to the Peace Corps. The type of information collected from potential donors to any of the funds includes name, address, gift amount, payment method and payment information, dedication message, donor intent, status as a returned Peace Corps Volunteer, consent to be listed in the agency’s donor recognition page, consent to share name with Peace Corps Volunteer, and consent to receive information about agency activities and opportunities to donate to or partner with the Peace Corps. Personal information, such as credit card information, is necessary to: a) process donations to the agency, b) respond to donor intent regarding the donation (i.e. dedication message or in honor or in memory of or a restricted gift to support a specific activity or Volunteer community project), c) send donor recognition items, where applicable, and/or, d) send the requisite tax acknowledgement letter.

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Authorizing Statute(s): US Code: 22 USC 2509 (a)(4) Name of Law: Peace Corps Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 9957	02/17/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 12489	03/04/2022
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Call-in Donation Form	PC-2143 C	Call-in Donation Form
Mail-in or Phone-In Donation Form	PC-2143B	Peace Corps Mail-in or Phone-In Donation form
Online Donation Form	PC-2143 A	Online Donation form

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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	900	0	0	-12,100	-130	13,130
Annual Time Burden (Hours)	150	0	0	-2,016	-22	2,188
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to: Miscellaneous Actions

Short Statement: This burden is the annual burden, not the total over three years, as explained in the Supplementary Statement, #15. Both the annual burden and a three-year burden are shown in #14 to demonstrate a crosswalk to the previous submission. Earlier form C is retired and form B can will be used for phone-in donations, since phone-in donations are extremely rare. Also, there was a small financial change for no longer using "return postage cost."

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Annual Cost to Federal Government: $17,150

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

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Common Form ICR:  No

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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: 06/05/2022

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