Information Collection

AmeriCorps Exit Survey

IC 214239 under ICR 202404-3045-001 · OMB 3045-0094.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 AmeriCorps Exit Survey	Form and Instruction
Form 1 AmeriCorps Exit Survey AmeriCorps Exit Survey	Form and Instruction
1 AmeriCorps Exit Survey Member Exit Survey_Survey Visual_Word Version_3_15_2024.docx	Form and Instruction
1 AmeriCorps Exit Survey Member Exit Survey_Survey Visual_Word Version_3_15_2024.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	1			www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 80,000

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	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	80,000	0	80,000
Annual IC Time Burden (Hours)	20,000	0	20,000
Annual IC Cost Burden (Dollars)	1,287,200	1,287,200	0

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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