Member Alumni Survey

Evaluation of Public Health AmeriCorps

Documents and Forms

Document Name Document Type
Form 01 Member Alumni Survey Form and Instruction
Form 01 Member Alumni Survey Form and Instruction
01 Member Alumni Survey and Early Exit Survey 01-Alumni and Early Exit Survey.docx MyAmeriCorps.gov Form and Instruction
01 Member Alumni Survey and Early Exit Survey 01-Alumni and Early Exit Survey.docx MyAmeriCorps.gov Form and Instruction
01 Revised Member Alumni Survey and Early Exit Survey 01-Alumni and Early Exit Survey_REVISED.docx www.americorps.gov Form and Instruction
01 Revised Member Alumni Survey and Early Exit Survey 01-Alumni and Early Exit Survey_REVISED.docx www.americorps.gov Form and Instruction

Information Collection (IC) Details

IC Title:	Member Alumni Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	01	Member Alumni Survey and Early Exit Survey	01-Alumni and Early Exit Survey.docx	MyAmeriCorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	01	Revised Member Alumni Survey and Early Exit Survey	01-Alumni and Early Exit Survey_REVISED.docx	www.americorps.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title: CNCS-04-CPO-MMF Member Management Files	FR Citation: 85 FR 3896

Number of Respondents: 1,562	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	1,562	1,562
Annual IC Time Burden (Hours)	1,562	1,562
Annual IC Cost Burden (Dollars)	73,976	73,976

Documents for IC

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.