Office of Gifts and Grants Management Donation Form

Forms and Documents

Document Name	Status
Form PC-2143B Phone-In Donation Form Form	Modified
Form PC-2143A Online Donation Form Form and Instruction	Modified
Supporting Statement 0420-0564 PC-2143 Donation GGM 2022 form.docx Supporting Statement A	2022-08-11
0420-0564 Authority 22 USC Ch 34 Sec 2509 (a)(4).PNG Supplementary Document	2022-06-05

IC Document Collections

IC ID	Document Title	Status
226964	Phone-In Donation Form Form	Modified
226962	Online Donation Form Form and Instruction	Modified

ICR Details

OMB Control No: 0420-0564	ICR Reference No: 202508-0420-001
Status: Received in OIRA	Previous ICR Reference No: 202205-0420-002
Agency/Subagency: PEACE	Agency Tracking No: PC-2143
Title: Office of Gifts and Grants Management Donation Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/08/2025

	Requested	Previously Approved
Expiration Date	36 Months From Approved	08/31/2025
Responses	13,050	900
Time Burden (Hours)	2,175	150
Cost Burden (Dollars)	0	0

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Abstract: Peace Corps’ Office of Gifts and Grants Management (GGM) uses the information to process and manage all private sector financial donations to the Peace Corps. The type of information collected from potential donors to any of the funds includes name, address, gift amount, payment method and payment information, dedication message, donor intent, status as a returned Peace Corps Volunteer, consent to be listed in the agency’s donor recognition page, consent to share name with Peace Corps Volunteer, and consent to receive information about agency activities and opportunities to donate to or partner with the Peace Corps. Personal information, such as credit card information, is necessary to: a) process donations to the agency, b) respond to donor intent regarding the donation (i.e. dedication message or in honor or in memory of or a restricted gift to support a specific activity or Volunteer community project), c) send donor recognition items, where applicable, and/or, d) send the requisite tax acknowledgement letter.

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Authorizing Statute(s): US Code: 22 USC 2509 (a)(4) Name of Law: Peace Corps Act
  

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:
	90 FR 2030	05/13/2025
30-day Notice:	Federal Register Citation:	Citation Date:
	90 FR 38518	08/08/2025
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Online Donation Form	PC-2143A	Online Donation Form
Phone-In Donation Form	PC-2143B	Peace Corps Mail-in or Phone-In Donation form

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ICR Summary of Burden

	Total Request	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	13,050	900	0	12,150	0	0
Annual Time Burden (Hours)	2,175	150	0	2,025	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: The Agency continues to move to a 100% Online Donation Form and phase out the phone donation method. However, we still have donors who prefer to speak to a person or cannot use the Internet to donate.

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Annual Cost to Federal Government: $17,925

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.     Yes

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.     Yes

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: 08/08/2025

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