AmeriCorps Member Application, Enrollment, and Exit Form

OMB 3045-0054

The Corporation is seeking approval of the attached AmeriCorps Member Application. This ICR will enable the public to apply to be AmeriCorps members. The following sentence has been added to the Public Burden and Privacy Statement: The information may be shared with other agencies, such as the Social Security Administration, through computer matching agreements for the purpose of verifying identity and citizenship status information provided by you in your application.

The latest form for AmeriCorps Member Application, Enrollment, and Exit Form expires 2022-02-28 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form SEC -618 AmeriCorps Member Application Form and Instruction
Form 1 AmeriCorps Member Application, Enrollment, and Exit Form Form and Instruction
National and Community Service Act of 1990.pdf Supplementary Document
Justification for Non-Substantive Change 12.7.12.docx Justification for No Material/Nonsubstantive Change
List of Revisions AC Member App 12.6.12.docx Supplementary Document
20220126 AmeriCorps Member Application Enrollment and Exit FormSSA v1.docx Supporting Statement A
Justification for Change in AmeriCorps Member Application 1.13.11.doc Justification for No Material/Nonsubstantive Change
AmeriCorps Member Application Form and Instruction
AmeriCorps Member Application, Enrollment, and Exit Form Form and Instruction

All Historical Document Collections

202202-3045-001 Approved with change	Revision of a currently approved collection	2022-02-09
201812-3045-001 Approved without change	Revision of a currently approved collection	2018-12-13
201510-3045-001 Approved without change	Reinstatement with change of a previously approved collection	2015-10-02
201212-3045-001 Approved without change	No material or nonsubstantive change to a currently approved collection	2012-12-07
201204-3045-002 Approved without change	Extension without change of a currently approved collection	2012-04-27
201101-3045-003 Approved without change	No material or nonsubstantive change to a currently approved collection	2011-01-24
200901-3045-001 Approved without change	Revision of a currently approved collection	2009-01-30
200510-3045-003 Approved without change	Revision of a currently approved collection	2005-10-28
200305-3045-004 Approved without change	No material or nonsubstantive change to a currently approved collection	2003-05-22
200208-3045-001 Approved with change	Revision of a currently approved collection	2002-08-07
199904-3045-001 Approved without change	New collection (Request for a new OMB Control Number)	1999-04-09