Volunteer Service Agreement Form

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form FCC Form A-384 Individuals or Households	Form and Instruction	Unchanged	Available
Extension_PRA Supporting Statement for Volunteer Service Agreement form FINAL_5.24.22.docx	Supporting Statement A	Uploaded 2022-05-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251168	Individuals or Households	Form and Instruction	Unchanged

ICR Details

OMB Control No: 3060-1298	ICR Reference No: 202205-3060-019
Status: Active	Previous ICR Reference No: 202205-3060-007
Agency/Subagency: FCC	Agency Tracking No: OMD-IO
Title: Volunteer Service Agreement Form
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Delegated
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/25/2022
	Date Received in OIRA: 05/25/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2025	36 Months From Approved	07/31/2022
Responses	140	0	25
Time Burden (Hours)	35	0	6
Cost Burden (Dollars)	0	0	0

---

Abstract: 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.

---

Authorizing Statute(s): 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
  

Citations for New Statutory Requirements: None

---

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

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 14010	03/11/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 14010	03/11/2022
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

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

---

ICR Summary of Burden

table that charts list of burden

	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

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: No

Burden Reduction Due to:

Short Statement: 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.

---

Annual Cost to Federal Government: $0

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

---

Common Form ICR:  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:

(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: 05/25/2022

---