Information Collection

Childcare Application Forms

IC 217805 under ICR 202409-3045-003 · OMB 3045-0142.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Childcare Application Forms	Form and Instruction
Form 1 Provider Application Childcare Application Forms	Form and Instruction
Form 2 Member Application Childcare Application Forms	Form and Instruction
Form 3 Childcare Attendance Sheet Childcare Application Forms	Form and Instruction
Form 4 Statement of Work Activity Childcare Application Forms	Form and Instruction
Form 5 Member Update Form Childcare Application Forms	Form and Instruction
Form 6 Childcare Payment Authorization Childcare Application Forms	Form and Instruction
Form 7 AmeriCorps Unlicensed Provider Affidavit Childcare Application Forms	Form and Instruction
Form 8 Program Certification of Active Service Childcare Application Forms	Form and Instruction
1 Provider Application PROVIDER APPLICATION_2025.docx www.nationalservice.gov	Form and Instruction
1 Provider Application PROVIDER APPLICATION_2025.docx www.nationalservice.gov	Form and Instruction
2 Member Application MEMBER APPLICATION_2025.docx www.nationalservice.gov	Form and Instruction
2 Member Application MEMBER APPLICATION_2025.docx www.nationalservice.gov	Form and Instruction
3 Childcare Attendance Sheet Attendance Sheet Invoice.pdf www.nationalservice.gov	Form and Instruction
3 Childcare Attendance Sheet Attendance Sheet Invoice.pdf www.nationalservice.gov	Form and Instruction
4 Statement of Work Activity STATEMENT OF WORK ACTIVITY.docx www.nationalservice.gov	Form and Instruction
4 Statement of Work Activity STATEMENT OF WORK ACTIVITY.docx www.nationalservice.gov	Form and Instruction
5 Member Update Form MEMBER UPDATE FORM.docx www.nationalservice.gov	Form and Instruction
5 Member Update Form MEMBER UPDATE FORM.docx www.nationalservice.gov	Form and Instruction
6 Childcare Payment Authorization Payment Authorization.docx www.americorps.gov	Form and Instruction
6 Childcare Payment Authorization Payment Authorization.docx www.americorps.gov	Form and Instruction
7 AmeriCorps Unlicensed Provider Affidavit Unlicensed Provider Affidavit.docx www.americorps.gov	Form and Instruction
7 AmeriCorps Unlicensed Provider Affidavit Unlicensed Provider Affidavit.docx www.americorps.gov	Form and Instruction
8 Program Certification of Active Service Certification of Active Service.docx www.americorps.gov	Form and Instruction
8 Program Certification of Active Service Certification of Active Service.docx www.americorps.gov	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Childcare Application Forms

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	2	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	3	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	4	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	5	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	6	www.americorps.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	7	www.americorps.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	8	www.americorps.gov	Yes	Yes	Fillable Fileable Signable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title: CNCS-06-CPO-ACB-AmeriCorps Child Care Benefit System

FR Citation: 84 FR 46002

Number of Respondents: 1,040

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	1,040	-1,060	2,100
Annual IC Time Burden (Hours)	520	-530	1,050
Annual IC Cost Burden (Dollars)	11,638	-11,861	23,499

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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