SORN Volunteer Applicant and Service Records System

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Report of Dental Examinitaion

SORN Volunteer Applicant and Service Records System

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MS 897, Attachment B
November 2010

Safeguards: Paper records are maintained in lockable file cabinets. All records are maintained in secure,
access-controlled areas or buildings.
Retention and disposal: Records are maintained at Peace Corps headquarters and domestic and
overseas field offices for three years after the individual leaves the agency or performs the travel, and are
then destroyed.
System Manager:
Director, Transportation Division, Office of Administrative Services, Peace Corps, 1111 20th St., NW,
Washington, DC 20526 and the office heads of Peace Corps’ domestic and overseas field offices.
Procedures for notification, access, and contesting:
Any individual who wants to know whether this system of records contains a record about him or her,
who wants access to his or her record, or who wants to contest the contents of a record, should make a
written request to the System Manager. Requesters will be required to provide adequate identification,
such as a driver's license, employee identification card, or other identifying document. Additional
identification may be required in some instances. Requests for correction or amendment must identify
the record to be changed and the corrective action sought. Complete Peace Corps Privacy Act
procedures are set out in 22 CFR Part 308.
Record source categories:
Record subject, supervisors, or other Peace Corps staff.

PC-17 – PEACE CORPS – [RETAINED FROM 1985 SYSTEMS OF RECORDS]
System name:
Volunteer Applicant and Service Records System
System Location:
This system is made up of subsystems which are located agency wide in Peace Corps offices. These
locations are (a) Headquarters; (b) three Service Center offices and area and sub-area Recruitment
offices; and (c) each Peace Corps overseas program office. The number of Peace Corps overseas offices
fluctuates as programs are added or withdrawn. Specific addresses will be provided upon request to the
Director of Administrative Services. Any particular country in which Peace Corps maintains a program
may be addressed by writing to the Country Director, Peace Corps, c/o the American Embassy in the
country.
Categories of Individuals covered by the system:
Current and former Peace Corps Volunteers, Trainees and applicants for Volunteer service including
Peace Corps United Nations Volunteers. A record may exist in a subsystem depending on whether a
record was established as part of the application, selection, placement, and service process.
Categories of records covered by the system:
This major system covers a number of temporary and permanent records established during the
application, selection, placement, training and service stages. Most information maintained in this system
is furnished by the individual. Generally, the individual is aware of any necessary investigations being
conducted and is either counseled or authorizes such investigations. As the record progresses through
the subsystems, generally, the following folders may be established: PCV Applicant File; Medical File;
and Trainee/Volunteer Service File. If certain situations warrant, a Special Services file may be

MS 897, Attachment B
November 2010

established. These records are explained in detail in the following paragraphs. At the processing and
program support desk levels temporary day to day sets of records may be used or set up to meet the
needs of work processes. This information is usually extracted from the official record or is a duplicate
of information contained in the official record and is utilized only as long as needed for a particular
decision, project or period of service. Upon completion of the use of such records they are destroyed or,
in the case of a permanent document or record, are forwarded to the peace Corps Records Center for
retirement.
(1)

Volunteer Applicant Folder and Computer Based Record: This record contains forms
related to the applicant process such as the application, references, overseas suitability
assessments, invitation to training, trainee enrollment forms correspondence relating to the
application, copies of other application documents, such as a peace Corps background
investigation form, evaluator-recruiter interview forms. Information is extracted from the
official record hard copy to create a computer record which is used to track progress, issue
labels for correspondence to the applicant and account for the establishment, retirement and
ultimate destruction of the individual record. Statistical information, without personal
identifies, is used from the computer record.

(2)

Trainee and Volunteer Service Pay Folder and Computer Based Record: This record
contains correspondence, forms related to pay allowances, travel and service such as, the
Oath, designation of beneficiary, address, social security number, duty station, next of kin,
trainee registration form, service and termination documents. Information is coded from
hard copy documents to create a computer record for pay and verification of service
purposes.

(3)

Medical Folder: The medical record contains medical examination forms and fitness for duty
reports, medical claims, correspondence and cables, medical histories, payment records,
record of the consulting physician, treatment, hospitalization and disposition of the case, and
history of psychiatric or psychological treatment.

(4)

Special Services Folder: This record contains information pertaining to any unusual or
extraordinary action or circumstances happening during service or causing the termination of
the Volunteer or Trainee. These records contain details of re-enrollments, re-instatements,
death or termination. Details include name, country of assignment, program number, dates
of the action, and supportive documentation. Supportive documentation would include
termination reports, staff recommendations, cables, financial information, travel
arrangements and medical clearance. Death cases may also include an autopsy report,
documentation of account of the death, designation of beneficiary, policy report, death
certificate, correspondence related to final arrangements, money payments and other
financial matters.

(5)

Overseas Post Service and Medical Records: Contains correspondence and forms relating to
in country service such as records of all payments or accrued credit to Volunteers and
Trainees, advances or other items due to the government from Volunteers or Trainees,
monthly living allowances, leave allowances, settling in allowances, property assignments.
The medical record is maintained at post by the Peace Corps Health Official. It contains the
entrance physical and dental examination records and record of treatment received while in
Peace Corps.

(6)

United Nations Volunteer Records: These records contain applications, correspondence
related to the applicant/placement process, other records connected with the application,
training and placement of person wishing to serve or serving as United Nations Volunteers.

MS 897, Attachment B
November 2010

For short periods of time references furnished by the applicant in support of the UNV
application are kept in the UNV folder until the PC Applicant Folder is received from the
Office of Placement by Multilateral programs. Then the UNV references, along with the
UNV application, are forwarded to Geneva/UNV. Medical history forms for UNV
applicants are forwarded by the examining facility to Peace Corps Office of Medical
Services, who, after medical clearance by Peace Corps, forward them to the Medical Office,
Geneva/UNV. At the end of service or inactivation of the record the UNV record is
forwarded to the Peace Corps Record Center for combining and retirement as regular Peace
Corps Volunteer records.
Authority for Maintenance of the System:
The Peace Corps Act, 22 U.S.C. 2501 et seq., and the Budget and Accounting Act of 1950.
Purpose(s):
This system was established to maintain records of individuals who apply for Peace Corps Volunteer
service and to record resulting actions taken on the applications and service.
Routine Uses of Records Maintained in the System, Including Categories of Users and the
Purposes of such Uses:
The contents of these records may be disclosed and used as follows:
(a)

As stated in our general routine uses unless specifically exempted under this heading.

(b)

To Peace Corps Volunteer host country officials to obtain visas, inform of pending arrival of
the Trainee/Volunteer and for review of their qualifications for a program.

(c)

To the Trainee/Volunteer’s family or next of kin so that he or she may be located in case of
emergency.

(d)

To the Social Security Administration for crediting of social security accounts and reports
withholdings.

(e)

To the Internal Revenue Service to report on taxes paid and for income purposes.

(f)

To Federal agencies having a need to verify Volunteer eligibility for Federal employment
under provision of Executive Order 11103.

(g)

To the Treasury Department for purposes of issuing payroll checks, readjustment allowance
checks or to report overpayments.

(h)

To appropriate overseas U.S. Government agencies for monthly payroll preparation.

(i)

To verify active or former Volunteer service.

(j)

Regarding the United Nations Volunteers records: In addition to our general routine uses
the contents of these records may be disclosed and used as follows:

(k)

(1)

To designated officers and employers of the United Nations having a responsibility
for the selection and placement of U.N. Volunteers.

(2)

To officials of a proposed host country desiring the assignment or placement of
U.N. Volunteers.

Regarding medical records: Notwithstanding subsections (a) through (j), in addition to our
general routine uses the medical records may be disclosed or used only as follows:

MS 897, Attachment B
November 2010

(1)

To the Office of Workers’ Compensation Programs, U.S. Department of Labor in
connection with claims under the Federal Employee’s Compensation Act.

(2)

To a physician or other medical personnel treating or involved in the medical
treatment and/or care of an applicant, trainee or Volunteer and having a need for
such records for the provision of the medical treatment or care. In situations where
it is practicable, the individual’s consent will be obtained before releasing such
information.

(3)

To psychiatrists or clinical psychologists when necessary for treatment. To the extent
practicable disclosure will not be made without approval of the individual.

(4)

In death cases to notify designated life and/or personal property insurance
companies to obtain payment of insurance benefits; to notify the Office of the Vice
President for the preparation of condolence letters; to the family and next of kin; and
Department of State.

(l)

To any educational institutions with which the Peace Corps has a Fellows/USA or Masters
International agreement which requires access to Volunteer or Returned Peace Corps
Volunteer contact information in order to meet the terms of the agreement.

(m)

To Returned Peace Corps Volunteer organizations furthering the Peace Corps' recruiting or
third goal activities. The information released will be limited to contact information.

Policies and practices for storing, retrieving, accessing, retaining, and disposing of records in the
system:
Storage: Records are maintained in folders, log books, cards, magnetic tape or disc packs with tape
backup and are filed in metal filing cabinets with manipulation proof combination lock or in a room
with a combination lock in the door, or in a locked room when not in use.
Retrievability: The majority of the subsystem records are retrievable alphabetically by the last name. A
few are retrievable by the social security number; by subject headings but access may be gained by
reference to an alphabetical name index; or by alphabetical order by country of assignment.
Safeguards: Records are generally available only to Peace Corps employees with specifically assigned
duties which require working with the records on a day to day basis. They are available to other Peace
Corps employees having the need for such records in the performance of their official duties. Personnel
screening is employed to prevent unauthorized disclosure. Officials or employees having access to the
security investigation records are required to have an appropriate security clearance.
Retention and disposal: Most Volunteer records are kept no longer than seven years. The Volunteer
personnel and Payroll Computer Record and the Volunteer Description of Service records are kept
permanently.
Medical records are destroyed as follows:
(1)

Records of rejected applicants are destroyed after 18 months;

(2)

Records of Trainees who do not become Volunteers and records of individuals who enroll as
Volunteers are destroyed 25 years from the completion of service or termination date.

Applicant records are destroyed as follows:
(1)

Immediately rejected applicant records are destroyed in six months;

(2)

Records of applicants rejected before reporting to training are destroyed in one year; and

MS 897, Attachment B
November 2010

(3)

Records of individuals who report to training are destroyed seven years from the completion of
service or termination date.

System Manager(s) and Address:
As the record flows from one state to another, or if a record is established for a specific purpose, the
system manager is the agency official responsible for that particular function. People unsure about
whom to contact, may contact the Peace Corps' FOIA/Privacy Officer at 1111 20th St., NW,
Washington, DC 20526.
(1)

The following system managers are located at 1111 20th St., NW, Washington, DC 20526:
Director of Placement and Staging; Chief of Health Benefits and Analysis Division; Chief of
Volunteer and Staff Payroll Services Branch; Director, Management Information and
Assessment Division; Supervisor, Medical Records Manager in the Division of Volunteer
Support;

(2)

The following system managers can be contacted at the overseas post of assignment: Peace
Corps Country Directors Overseas; Peace Corps Medical Officers Overseas.

Notification Procedure:
Any individual who wants to know whether this system of records contains a record about him or her,
who wants access to his or her record, or who wants to contest the contents of a record , should make a
written request to the System Manager. Requesters will be required to provide adequate identification,
such as a driver’s license, employee identification card, or other identifying document. Additional
identification may be required in some instances. Requests for correction or amendment must identify
the record to be changed and the corrective action sought. Complete Peace Corps Privacy Act
procedures are set out in 22 CFR part 308.
Record Source Categories:
Information is obtained from the individual; sources whom the individual has named; Peace Corps
employees and other Volunteer/Trainees; medical personnel who have treated an
applicant/Trainee/Volunteer or reviewed their medical records; medical contractors; U.S. Government
investigative agencies, including the Office of Personnel Management; The Merit Systems protection
Board and its Special Counsel; the Federal Labor Relations Authority; local law enforcement officials;
Peace Corps Host Country Nationals; Peace Corps Country American Embassy and Consulates, United
Nations Staff; and job supervisors.
Systems exempted from certain provisions of the act:
These records or portions of these records may be exempted by authority of 5 U.S.C. 552a (k) (5).

PC-18 – PEACE CORPS
System name:
Former Peace Corps Volunteers and Staff Database.
System location:
Office of Volunteer Support, Peace Corps, 1111 20th St., NW, Washington, DC 20526
Categories of individuals covered by the system:
Former Peace Corps staff and Volunteers.


File Typeapplication/pdf
File TitleMS 897, Attachment B
Authornfull
File Modified2012-07-12
File Created2012-07-12

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