Information Collection

AmeriCorps Member Application, Enrollment, and Exit Form

IC 251499 under ICR 202411-3045-001 · OMB 3045-0054.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 AmeriCorps Member Application, Enrollment, and Exit Form	Form and Instruction
Form 1 AmeriCorps Member Application AmeriCorps Member Application, Enrollment, and Exit Form	Form and Instruction
Form 2 AmeriCorps Enrollment and Exit Form AmeriCorps Member Application, Enrollment, and Exit Form	Form
1 AmeriCorps Member Application AmeriCorps Member Application_CLEAN.docx www.americorps.gov	Form and Instruction
1 AmeriCorps Member Application AmeriCorps Member Application_CLEAN.docx www.americorps.gov	Form and Instruction
2 AmeriCorps Enrollment and Exit Form 20220126 AmeriCorps Enrollment and Exit Forms.docx www.americorps.gov	Form
2 AmeriCorps Enrollment and Exit Form 20220126 AmeriCorps Enrollment and Exit Forms.docx www.americorps.gov	Form

IC Title:

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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1			www.americorps.gov	Yes	Yes	Fillable Fileable
Form	2			www.americorps.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title: AmeriCorps-04-CPO-MMF-Member Management Files (MMF)

FR Citation: 85 FR 3896

Number of Respondents: 521,000

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	521,000	0	521,000
Annual IC Time Burden (Hours)	390,750	0	390,750
Annual IC Cost Burden (Dollars)	20,182,238	7,235,388	12,946,850

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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