Information Collection

Early Exit Survey

IC 264739 under ICR 202311-3045-001 · OMB 3045-0199.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0199 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 01 Early Exit Survey	Form and Instruction
Form 01 Member Alumni Survey and Early Exit Survey Early Exit Survey	Form and Instruction
01 Member Alumni Survey and Early Exit Survey 01-Alumni and Early Exit Survey.docx	Form and Instruction
01 Member Alumni Survey and Early Exit Survey 01-Alumni and Early Exit Survey.docx	Form and Instruction

IC Title:

Early Exit Survey

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	01			MyAmeriCorps.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 443

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	443	443
Annual IC Time Burden (Hours)	443	443
Annual IC Cost Burden (Dollars)	20,980	20,980

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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