Information Collection

Public Health AmeriCorps Grantee Survey

IC 260453 under ICR 202503-3045-002 · OMB 3045-0137.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0137 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Public Health AmeriCorps Grantee Survey	Form and Instruction
Form 1 Public Health AmeriCorps Grantee Survey Public Health AmeriCorps Grantee Survey	Form and Instruction
1 Public Health AmeriCorps Grantee Survey 0137 - PHA Grantee Survey_EDITED-Clean.docx www.americorps.gov	Form and Instruction
1 Public Health AmeriCorps Grantee Survey 0137 - PHA Grantee Survey_EDITED-Clean.docx www.americorps.gov	Form and Instruction
0137 - PHA Grantee Survey_EDITED-Clean.docx Public Health AmeriCorps Grantee Survey	IC Document
0137 - PHA Grantee Survey_EDITED-Clean.docx Public Health AmeriCorps Grantee Survey	IC Document

IC Title:

Public Health AmeriCorps Grantee Survey

Agency IC Tracking Number:

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 12501

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

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 82

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	82	82
Annual IC Time Burden (Hours)	41	41
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Public Health AmeriCorps Grantee Survey		03/26/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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