Supporting Statement 0420-0564 PC-2143 Donation GGM 2022

Peace Corps, Office of Gifts and Grants Management
Donation Form, PC-2143
OMB Control Number 0420-0564
Supporting Statement A
A. JUSTIFICATION
1. Why is this collection necessary and what is the underlying legal authority?
Section 10(a)(4) of the Peace Corps Act authorizes the Director to accept gifts of voluntary
services, money, or property, for use in furtherance of the purposes of the Peace Corps Act, 22
USC § 2509(a)(4). The collection of this information is essential to the Peace Corps to fulfill
this authority for the acceptance of gifts. Peace Corps policy Manual Section (MS) 721 outlines
the agency’s parameters for acceptance of gifts and donations.
The Peace Corps Office of Gifts and Grants Management oversees the acceptance of gifts
and donations. It has two online donation programs to receive donations in support of its
mission: the Peace Corps Partnership Program, and the Peace Corps Fund. These are located on
the Peace Corps Donate page: https://www.peacecorps.gov/donate/?payment_amount=100
All donation options use the form PC-2143 A or B (the online donation form, or the option for a
mail-in or phone-in donation). The two donation programs are:
a. The Peace Corps’ Partnership Program (“Partnership Program” or PCPP) was established in
1964 to link interested donors with grassroots development projects in which Peace Corps
Volunteers are involved around the world. The Partnership Program supports Volunteers as
they work with their host communities to identify a local need and design a sustainable
solution.
b. The Peace Corps established the Peace Corps Fund in March 2011 as a means to receive nonPCPP donations to support special initiatives and other agency activities.
2. Use of the Information.
The Office of Gifts and Grants Management uses the information to oversee and manage all
private sector donations to the Peace Corps. The type of information collected from potential
donors to complete the donation funds process includes name, address, gift amount, payment
method and payment information, dedication message, donor intent, status as a returned Peace
Corps Volunteer, optional consent to be listed in the agency’s donor recognition page, optional
consent to share name with Peace Corps Volunteer, and optional 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.
The Peace Corps policy MS 721 outlines the parameters for acceptance of gifts by the agency.
Among those criteria is whether acceptance of the gift will either raise a question of impropriety
or conflict of interest. To comply with this requirement, the Peace Corps asks for information
about whether the donor is doing or seeking to do business with the Peace Corps.

Peace Corps, Office of Gifts and Grants Management
Donation Form, PC-2143
OMB Control Number 0420-0564
Supporting Statement A
3. Use of Information Technology.
The Peace Corps collects the information through electronic and mechanical means, primarily
through the Peace Corps donation webpage. The agency receives the majority of this
information via its web-based technology application. This is a faster, more secure process and
also reduces the amount of hard copy communication. The Peace Corps manages its online
donation form using Agency Customer Relationship Management System, which has an
approved Privacy Impact Assessment.
Form PC-2143A is the online donation form which collects information electronically via the
agency’s web portal. The donor is guided to click on tabs and input their information. The
payment information is processed with pay.gov.
Form PC-2143B is the form the donor uses by when not using the online donation portal. It may
be scanned and emailed, postal mail-in, or submitted as an in-person form used when a donor
contacts the office to make their donation by phone or appears in person to the office. The mailin form, PC-2143C, was merged with form PC-2143B to consolidate forms since the last
submission of this OMB Control Number. The donor is asked a series of questions and an
authorized staff collects the information. This payment information is referred to the Gifts and
Grants Management Administrative Officer and entered into a secure IT system with an
approved Privacy Impact Assessment. The Administrative Officer then either deletes any
scanned form, or shreds the form using a federally-approved shredder.
4. Does this collection duplicate any other collection of information?
No, the information that the Office of Gifts and Grants Management obtains through this
collection is unique; the financial donation information is not available for use or adaptation
from another cleared source. The Office of Gifts and Grants Management has oversight for the
management and documentation of donors’ gifts and contributions to the Peace Corps.
5. Describe any impacts on small business, and any methods used to minimize burden.
As the agency recommends and generally receives the majority of its information via web-based
technology, this e-collection approach reduces the donation transaction cost and eliminates any
need for hard copy communiqués on the part of small businesses or entities.
6. What are consequences if this collection is not conducted or conducted less frequently?
The information is collected only once at the time of donation. The agency would not be able to
process the donations, provide confirmation and tax deductibility information to the donors, or
otherwise manage the program without the information.
7. Are there any special circumstances that require the collection to be conducted in a
manner inconsistent with OMB guidelines?
There are no special circumstances that would cause the Peace Corps to conduct his information

Peace Corps, Office of Gifts and Grants Management
Donation Form, PC-2143
OMB Control Number 0420-0564
Supporting Statement A
collection in a manner inconsistent with 5 C.F.R. 1320.5 – 1320.6.
8. Provide the Federal Register notice and related public comments.
The agency’s 60-day notice was published in the Federal Register on February 17, 2021, 85 FR
79046. The Peace Corps did not receive any public comments during the 60-day period. The
30-Day notice was published on March 4, 2022, 87 FR 12489. The Peace Corps did not receive
any public comments during the 30-day period.
9. Are payments or gifts given to the respondents?
Donors may receive an agency-designated donor recognition gift that commensurate with their
giving level. The donor recognition items are for the donation, not the information provided.
10. Describe assurances of confidentiality.
This form does not provide any assurance of confidentiality to the respondent. This form
includes a Privacy Act Statement explaining the routine uses of the information collected under
the Privacy Act and System of Records Notice PC-10, Office of Private Sector Initiatives
Database. Information about the routine uses is provided on the Peace Corps Privacy web page:
https://www.peacecorps.gov/about/privacy/
11. Are any questions of a sensitive nature asked?
The donator’s credit card information is collected to complete the donation transaction on PC2143B for the mail-in or phone-in donation form.
12. Provide an estimate in hours of the burden on the respondent to complete this
collection.
Number of donations (respondents) – 1 year (2022)
b. Estimated number of project applications received:
d. Frequency of response:
e. Completion time:
f. Annual burden hours:
g. Number of forms received electronically (80%)
h. Number of forms received hardcopy (20%)
i. Number of phone-in donations (2022)

900
10
One time
10 minutes
150 hours
720
180
0

Number of donations (respondents) – 3 years (2022-2024)
b. Estimated number of project applications received:
d. Frequency of response:
e. Completion time:
f. Annual burden hours:
g. Number of forms received electronically (95%)
h. Number of forms received hardcopy (5%)
i. Number of phone-in donations (2022-2024)

12,000
1000
One time
10 minutes
666 hours
11,400
600
20

Peace Corps, Office of Gifts and Grants Management
Donation Form, PC-2143
OMB Control Number 0420-0564
Supporting Statement A
13. Describe the monetary burden to respondents (out of pocket costs) needed to complete
this collection
There will be no cost to respondents. The Peace Corps will provide, as needed, a return envelope
that covers postage.
14. Provide estimates of annualized cost to the Federal government.
Printing
(includes cost of paper, ink, printing labor)
(150 Thank You letters x 1 copy @ $0.05 b/c printout = $7.50)

$7.50

Mailing
($0.58 (postage cost) x 150 (mailings))

$87

Analyzing information and processing
(4 hours per week/ x 52 weeks = 208 hours per year)
($80,000 pay salary @ $41/hour x 208 hours = $8,528
(4 hours per week/ x 52 weeks = 208 hours per year)
($80,000 pay salary @ $41/hour x 208 = $8,528)

$17,056

TOTAL per annum
TOTAL LABOR HOURS

$ 17,150.50
416 hours per annum

15. Explain any changes to this collection since the previous submission.
Form versions B and C were consolidated into the B version for mail-in and phone-in donations.
The listed burden cost to the Federal government for the “Return postage costs” has been
removed from answer 14. This is no longer used with the shift to online donations.
The Office of Gifts and Grants Management (the program office) updated its annual cost burden
number for respondents and the annual cost to the Federal government to properly reflect the
annual average over a three-year period, as well as current fees. The previous burden
represented the collection over three years. This Supporting Statement provides both the annual
and three-year burden to serve as a crosswalk with the prior Supporting Statement.
16. Plans for Publication Information Collection Results.
This information will not be published for statistical use or complex analytical techniques. The
agency may on occasion, and with consent of the donor, acknowledge donors with a donor
recognition listing by name.
17. Displaying OMB Approval Expiration Date.
The Peace Corps is not requesting an exception to the certification requirements.

Peace Corps, Office of Gifts and Grants Management
Donation Form, PC-2143
OMB Control Number 0420-0564
Supporting Statement A
18. Explain each exception to the certification statement.
The agency is able to certify compliance with all provisions under Item 19 of OMB Form 83-I.
B. COLLECTIONS OF INFORMATION EMPLOYING STATISTICAL METHODS
This collection does not employ statistical methods.