Volunteer Service Agreement Form

ICR 202205-3060-019

OMB: 3060-1298

Federal Form Document

Forms and Documents
IC Document Collections
IC ID
Document
Title
Status
251168 Unchanged
ICR Details
3060-1298 202205-3060-019
Active 202205-3060-007
FCC OMD-IO
Volunteer Service Agreement Form
Extension without change of a currently approved collection   No
Delegated
Approved without change 05/25/2022
Retrieve Notice of Action (NOA) 05/25/2022
  Inventory as of this Action Requested Previously Approved
05/31/2025 36 Months From Approved 07/31/2022
140 0 25
35 0 6
0 0 0

The Volunteer Service Agreement Form is 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 requires individuals seeking volunteer positions to certify that they will comply with COVID-19 vaccine requirements for Federal workers established by Executive Order 14043 and other mandates.

EO: EO 14043 Name/Subject of EO: Requiring Coronavirus Disease 2019 Vaccination for Federal Employees
   EO: EO 13991 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
   US Code: 5 USC 3111 Name of Law: Acceptance of Volunteer Service
  
None

Not associated with rulemaking

  87 FR 14010 03/11/2022
87 FR 14010 03/11/2022
No

1
IC Title Form No. Form Name
Individuals or Households FCC Form A-384 Volunteer Service Agreement

  Total Approved 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 140 25 0 0 115 0
Annual Time Burden (Hours) 35 6 0 0 29 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
Based on the most currently available data, the Commission has re-evaluated its previous figures, resulting in adjustments/increases to the total number of respondents and total annual responses by 115 and the total annual burden hours by 29 hours. There are no program changes.

$0
No
    Yes
    Yes
No
No
No
No
Warren Firschein 202 418-0844 [email protected]

  No

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.
05/25/2022


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