Information Collection

2023 Revision

IC 249441 under ICR 202502-3045-002 · OMB 3045-0035.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2023 Revision	Form and Instruction
Form 1 Application Instructions 2023 Revision	Form and Instruction
Form 2 Progress Report Instructions 2023 Revision	Form and Instruction
Form 3 Independent Living Survey 2023 Revision	Form and Instruction
Form 4 Respite Survey 2023 Revision	Form and Instruction
Form 5 Progress Report Supplement 2023 Revision	Form and Instruction
1 Application Instructions 20210730 AmeriCorps Seniors Grant Application Instructions.docx www.americorps.gov	Form and Instruction
1 Application Instructions 20210730 AmeriCorps Seniors Grant Application Instructions.docx www.americorps.gov	Form and Instruction
2 Progress Report Instructions 20210730 AmeriCorps Seniors PPR Instructions.docx www.americorps.gov	Form and Instruction
2 Progress Report Instructions 20210730 AmeriCorps Seniors PPR Instructions.docx www.americorps.gov	Form and Instruction
3 Independent Living Survey 20210730 AmeriCorps Seniors Independent Living Survey.docx www.americorps.gov	Form and Instruction
3 Independent Living Survey 20210730 AmeriCorps Seniors Independent Living Survey.docx www.americorps.gov	Form and Instruction
4 Respite Survey 20210730 AmeriCorps Seniors Respite Survey.docx www.americorps.gov	Form and Instruction
4 Respite Survey 20210730 AmeriCorps Seniors Respite Survey.docx www.americorps.gov	Form and Instruction
5 Progress Report Supplement 0035 - ACS PRS_EDITED-Clean.docx www.americorps.gov	Form and Instruction
5 Progress Report Supplement 0035 - ACS PRS_EDITED-Clean.docx www.americorps.gov	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

2023 Revision

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.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	2	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	3	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	4	www.americorps.gov	Yes	Yes	Fillable Fileable
Form and Instruction	5	www.americorps.gov	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,250

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	6,250	6,250
Annual IC Time Burden (Hours)	6,250	6,250
Annual IC Cost Burden (Dollars)	309,313	309,313

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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