Form FCC Form A-384 FCC Form A-384 Volunteer Service Agreement

FCC Form A-384 OMB Control No. 3060-1298

Estimated Time Per Response: 0.25 hours

Revised January 2022

	FEDERAL COMMUNICATIONS COMMISSION VOLUNTEER SERVICE AGREEMENT
	Part I	The Civil Service Reform Act of 1978 authorized Federal agencies to establish programs designed to provide educationally related work assignments for students in a non-pay status. The Act provides that heads of agencies may accept, subject to regulations issued by the Office of Personnel Management, volunteer service for the United States if the service (l) is performed by a student, with permission of the institution at which the student is enrolled; (2) is to be uncompensated; and (3) will not displace any employee. A student participating under any agency volunteer program is not considered to be a Federal employee for any purposes other than (1) injury compensation, (2) laws related to the Tort Claims Act, and (3) eligibility to participate in FCC-sponsored transit subsidy programs. Any claims related to injury compensation of the Tort Claims Act would be subject to adjudication by the Department of Labor or the Department of Justice, respectively. Service is not creditable for leave accrual or any other employee benefits. This arrangement would be subject to termination at any time at the discretion of the Federal Communications Commission.
	Part II	RESPONSIBILITIES OF THE STUDENT: stay enrolled at least on a half-time basis in the educational Institution; adhere to the FCC bar on disclosure and use of nonpublic information, 47 CFR 19.735-203, and the Standards of Ethical Conduct for Employees of the Executive Branch, 5 CFR Part 2635, including but not limited to subpart D, which implements 18 USC section 208 [Note: The conflict of interest statutes codified at 18 USC 202-209 shall not otherwise apply to student volunteers.]; comply with regulations and policies pertaining to COVID-19 vaccination requirements for Federal workers, including the submission of proof of vaccination if requested; demonstrate the capacity to positively absorb the educational experience provided; understand their relationship with the FCC as being that of a guest to a host and that they are not considered Federal employees. RESPONSIBILITIES OF THE INSTITUTION: designate a representative to work with the agency liaison officer; inform all likely student candidates of the FCC’s education opportunities; refer all interested and qualified candidates to the FCC without discrimination; correlate work and study in a manner that will assure maximum learning on the part of each student; furnishes the FCC with requested information about the student’s field of study and academic standing; informs the FCC of any change in a student’s status, including termination of study, change from full-time to part-time enrollment, shifts other major areas of study, and failure to maintain required standards of the institution or the FCC. RESPONSIBILITIES OF FCC: designates a staff member to maintain liaison with the educational institution; informs the institution of available work opportunities; establishes work schedules which accommodate the education calendar of the institution and enable the students to meet the requirements of both the institution and the FCC for completion of the program; selects appointees from among students referred by the institution without discrimination on the basis of race, ethnic background, creed, national origin, sex or age; meets with the student periodically to discuss the student’s progress and resolve issues of concern; processes all personnel actions relating to the student’s service and keep all necessary records; responds promptly to referrals of students by colleges.
	Part III	The Federal Communications Commission hereby agrees to provide the student named below with orientation, education and training experience. There is no commitment on the pan of the FCC to employ this student at the completion of the education training/experience.
	1. Name of Student		2. Beginning Date			3. Ending Date
	4. Organizational Unit of FCC		5. Duty Hours From: To:			6. Work Days (i.e., Mon. & Tues.)
	7. Name of School					8. School Telephone Number
	Part IV	As a representative of the Federal Communications Commission, I approve the terms of this agreement and pledge the support of the Federal Communications Commission, in fulfilling the agreement.
	9. Signature of FCC Representative			10. Date Signed
	I l. Typed Name of FCC Representative			12. Title			13. Telephone Number
	Part V	As a representative of the student named below, I approve the terms of this agreement and pledge the support of my school in fulfilling this agreement.
	14. Signature of School Representative			15. Date Signed
	16. Typed Name of School Representative			17. Title			18. Telephone Number
	Part VI	As a student participant, I accept the terms of this agreement and agree to support my school and the Federal Communications Commission in fulfilling this agreement.
	19. Signature of Student				20. Date Signed
	21. Typed Name of Student				22. Title

Privacy Act Statement 

Authority: The authority to collect this information derives from 5 U.S.C. 3111, Acceptance of volunteer service. Certification of compliance with COVID-19 vaccine requirements for Federal workers derives from several sources, including most recently Executive Order 13991, Protecting the Federal Workforce and Requiring Mask-Wearing; Executive Order 14043, Requiring Coronavirus Disease 2019 Vaccination for Federal Employees; and OMB Memorandum M 21–15, COVID–19 Safe Federal Workplace: Agency Model Safety Principles (Jan. 24, 2021), as amended. 

Purpose and Routine Uses: The information collected on this form is to allow the FCC to determine an individual’s eligibility to participate in a volunteer service program administered by the agency. The federal government may release information contained in this system to other individuals and entities when necessary and appropriate under 5 U.S.C. § 552a(b) of the Privacy Act, which may include but is not limited to the routine uses identified in the governmentwide System of Records Notice (SORN) OPM/GOVT-1 General Personnel Records, posted at https://www.opm.gov/information-management/privacy-policy/sorn/opm-sorn-govt-1-general-personnel-records.pdf and the following FCC SORNs: FCC/OMD-16 (Personnel Security Files); FCC/OMD-24 (Physical Access Control System); FCC/OMD-32 (FCC Telework Program); and FCC/OMD-33 (Ensuring Workplace Health and Safety in Response to a Public Health Emergency), all posted at https://www.fcc.gov/managing-director/privacy-transparency/privacy-act-information#systems. Failure to provide the information requested on this form will result in an individual being deemed ineligible for volunteer service at the FCC. 

Paperwork Reduction Act Statement

In accordance with the Paperwork Reduction Act (44 U.S.C. 3501), the Federal Communications Commission collects information necessary to manage the security, safety, reporting, recruitment, placement, training, benefits, and experience of volunteers. Information requested in this form is required to obtain a benefit. According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. OMB has approved this collection of information and assigned Control No. 3060-1298.

Estimated Burden Statement: We estimate public reporting for this collection of information to average 15 minutes, including time for reviewing instructions, gathering and maintaining data and completing and reviewing the form. Direct comments regarding the burden estimate or any other aspect of the information collection to the Federal Communications Commission, Office of Managing Director, AMD PERM, Washington, DC 20554, Paperwork Reduction Act Project (3060-1298). We will also accept your PRA comments via the Internet if you send an e-mail to [email protected].

THIS NOTICE IS REQUIRED BY THE PAPERWORK REDUCTION ACT OF 1995, PUBLIC LAW 104-13, OCTOBER 1, 1995, 44 U.S.C. SECTION 3507.

Notice To Program Participants

By signing this application, the program participants (s) understand(s) s/he may be subject to a reference check, background check, and/or criminal history inquiry. Volunteers are not considered Federal employees for any purposes other than (1) injury compensation, (2) laws related to the Tort Claims Act, and (3) eligibility to participate in FCC-sponsored transit subsidy programs. Volunteer service is not creditable for leave accrual or any further benefit. However, volunteer service is creditable work experience.

The federal government prohibits discrimination in all programs and activities on the basis of race, color, national origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs (i.e. youth programs may have age limits by law). To file a complaint of discrimination, write DOI, Director, Office of Civil Rights, 1849 C Street, NW, Mail Stop 4359, Washington, District of Columbia, 20240, Voice (202)-208-5693 FedRelay: 800-877-8339. Fax: 202-208-6112. The Federal Relay Service (FedRelay) allows individuals who are deaf, hard-of-hearing, deaf/blind, or have speech disabilities to have equal communication access. Calls are relayed using specially trained Communications Assistants.