Information Collection

AmeriCorps Seniors Grant Application and Reports

IC 249441 under ICR 202606-3045-004 · OMB 3045-0035.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Application Instructions AmeriCorps Seniors Grant Application and Reports	Form and Instruction
Form 2 Progress Report Instructions AmeriCorps Seniors Grant Application and Reports	Form and Instruction
Form 3 Independent Living Survey AmeriCorps Seniors Grant Application and Reports	Form and Instruction
Form 4 Respite Survey AmeriCorps Seniors Grant Application and Reports	Form and Instruction
Questions moved from PRS to PPR.docx	Other-List of Questions to Be Moved
1 Application Instructions 20210730 AmeriCorps Seniors Grant Application Instructions.docx	Form and Instruction
2 Progress Report Instructions 20210730 AmeriCorps Seniors PPR Instructions.docx	Form and Instruction
3 Independent Living Survey 20210730 AmeriCorps Seniors Independent Living Survey.docx	Form and Instruction
4 Respite Survey 20210730 AmeriCorps Seniors Respite Survey.docx	Form and Instruction

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.	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
Other-List of Questions to Be Moved to PPR		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: 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
	Requested	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	5,000	-1,250	0	6,250
Annual IC Time Burden (Hours)	5,000	-1,250	0	6,250
Annual IC Cost Burden (Dollars)	336,950	-61,863	89,500	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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