Information Collection

Surveys

IC 265144 under ICR 202402-3045-001 · OMB 3045-0200.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0200 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 01 Surveys	Form and Instruction
Form 01 Station Staff Survey Surveys	Form and Instruction
Form 02 Volunteer Survey - Current and Former Volunteers Surveys	Form and Instruction
Form 03 Caregiver Survey Surveys	Form and Instruction
Form 04 Senior Companion Client Survey Surveys	Form and Instruction
01 Station Staff Survey Station Staff interview.docx	Form and Instruction
01 Station Staff Survey Station Staff interview.docx	Form and Instruction
02 Volunteer Survey - Current and Former Volunteers Volunteer Survey.docx	Form and Instruction
02 Volunteer Survey - Current and Former Volunteers Volunteer Survey.docx	Form and Instruction
03 Caregiver Survey Caregiver Survey.docx	Form and Instruction
03 Caregiver Survey Caregiver Survey.docx	Form and Instruction
04 Senior Companion Client Survey Senior Companion Survey.docx	Form and Instruction
04 Senior Companion Client Survey Senior Companion Survey.docx	Form and Instruction

IC Title:

Surveys

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	Station Staff Survey	Station Staff interview.docx	americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	02	Volunteer Survey - Current and Former Volunteers	Volunteer Survey.docx		No		Paper Only
Form and Instruction	03	Caregiver Survey	Caregiver Survey.docx		No		Paper Only
Form and Instruction	04	Senior Companion Client Survey	Senior Companion Survey.docx		No		Paper Only

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 4,958

Number of Respondents for Small Entity: 1

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,958	4,958
Annual IC Time Burden (Hours)	2,310	2,310
Annual IC Cost Burden (Dollars)	109,423	109,423

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.