AmeriCorps Seniors Grant Applications, Progress Reporting, Independent Living and Respite Surveys

Forms and Documents

Document	Type	Status	Availability
Form 5 Progress Report Supplement	Form and Instruction	Modified	Repair queued
Form 4 Respite Survey	Form and Instruction	Modified	Repair queued
Form 3 Independent Living Survey	Form and Instruction	Modified	Available
Form 2 Progress Report Instructions	Form and Instruction	Modified	Available
Form 1 Application Instructions	Form and Instruction	Modified	Repair queued
Form 1 2023 Revision	Form and Instruction	Modified	Repair queued
0035- Nonsub Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-26	Available
0035- Nonsub Justification.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2025-03-26	Repair queued
42 U.S.C. 5001 5011 5013 5028 5056.pdf	Supplementary Document	Uploaded 2023-09-11	Available
42 U.S.C. 5001 5011 5013 5028 5056.pdf	Supplementary Document	Uploaded 2023-09-11	Repair queued
Emergency Memo 3.10.21.pdf	Supplementary Document	Uploaded 2021-03-15	Available
Emergency Memo 3.10.21.pdf	Supplementary Document	Uploaded 2021-03-15	Repair queued
OMB Change Request Form_9_10_15 Final.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2015-09-10	Available
OMB Change Request Form_9_10_15 Final.pdf	Justification for No Material/Nonsubstantive Change	Uploaded 2015-09-10	Missing upstream
3045-0035 sr corp app_CLEAN.docx	Supporting Statement A	Uploaded 2023-09-12	Available
3045-0035 sr corp app_CLEAN.docx	Supporting Statement A	Uploaded 2023-09-12	Repair queued

IC Document Collections

IC ID	Collection	Type	Status	Form
249441	2023 Revision	Form and Instruction	Modified	Progress Report Supplement
249441	2023 Revision	Form and Instruction	Modified	Respite Survey
249441	2023 Revision	Form and Instruction	Modified	Independent Living Survey
249441	2023 Revision	Form and Instruction	Modified	Progress Report Instructions
249441	2023 Revision	Form and Instruction	Modified	Application Instructions
249441	2023 Revision	Form and Instruction	Modified

ICR Details

OMB Control No: 3045-0035	ICR Reference No: 202502-3045-002
Status: Active	Previous ICR Reference No: 202307-3045-004
Agency/Subagency: CNCS	Agency Tracking No:
Title: AmeriCorps Seniors Grant Applications, Progress Reporting, Independent Living and Respite Surveys
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/27/2025
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/26/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2026	09/30/2026	09/30/2026
Responses	6,250	0	6,250
Time Burden (Hours)	6,250	0	6,250
Cost Burden (Dollars)	309,313	0	309,313

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Abstract: The Corporation for National and Community Service (CNCS), doing business as AmeriCorps, is submitting a revision of this information collection, which includes the application for AmeriCorps Seniors grant programs, progress report, progress report supplement (PRS), and survey instruments related to the AmeriCorps Seniors program. Revisions are being made to the PRS only.

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Authorizing Statute(s): PL: Pub.L. 106 - 170 5013 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
   PL: Pub.L. 106 - 170 5011 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
   PL: Pub.L. 106 - 170 5082 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
   PL: Pub.L. 106 - 170 5001 Name of Law: Domestic Volunteer Service Act (DVSA) as Amended
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 25625	04/27/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 44290	07/12/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
2023 Revision	1, 2, 3, 4, 5	Application Instructions ,   Progress Report Instructions ,   Independent Living Survey ,   Respite Survey ,   Progress Report Supplement

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	6,250	6,250	0	0	0	0
Annual Time Burden (Hours)	6,250	6,250	0	0	0	0
Annual Cost Burden (Dollars)	309,313	309,313	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: AmeriCorps Seniors updated the estimated Hours per Response from 0.42 to 1 hour due to a re-estimation of the amount of burden that the collection imposes. AmeriCorps’ new estimate is based on consultation with a sample of potential respondents. The decrease in adjustment results from removal of information collections (ICs) from prior years so that this ICR includes only the most current versions of the instruments in use. In most of the instruments, the agency has not made any change to the collection itself since the last approval, and thus there is simply an adjustment to a previously approved burden estimate. The only revisions being made to an information collection instrument are revisions to the Progress Report Supplement, which deletes several questions for which data is not currently used and adds a fewer number of questions that now relate to AmeriCorps’ Strategic Plan goals. The newly added questions are needed to report out on Strategic Plan objectives, specifically the socioeconomic status of AmeriCorps Seniors volunteers. The revision results in an increase in hours for the IC of 3,625 hours. However, the two legacy ICs that are deleted result in a decrease of 20,020 hours (17,820 hours + 2,200 hours), resulting in an overall decrease in hours of 16,395 for this ICR. The number of responses also decreases because the legacy ICs are deleted, resulting in a decrease of 5,650 responses (1,250 responses + 4,400 responses) for this ICR.

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Annual Cost to Federal Government: $185,588

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/26/2025

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