OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Evaluation of Public Health AmeriCorps

OMB 3045-0199 ยท CNCS.

OMB 3045-0199

This information collection includes a survey of Public Health AmeriCorps (PHA) members, a survey of PHA grantees and a PHA grantee training and technical assistance form, and questions for PHA grantees who choose to participate in focus groups, to allow AmeriCorps to evaluate the success of PHA in meeting its goals of addressing public health needs and developing the next generation of public health leaders.

The latest form for Evaluation of Public Health AmeriCorps expires 2027-04-30 and is listed under ICR 202503-3045-005.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 06 Grantee Technical Assistance and Training FormForm and Instruction
Form 06 Training and TA FormForm and Instruction
Form 02 Grantee SurveyForm and Instruction
Form 02 Grantee SurveyForm and Instruction
Form 01 Member Alumni Survey and Early Exit SurveyForm and Instruction
Form 01 Early Exit SurveyForm and Instruction
Form 01 Revised Member Alumni Survey and Early Exit SurveyForm and Instruction
Form 01 Member Alumni SurveyForm and Instruction
0199- Nonsub Justification.docxJustification for No Material/Nonsubstantive Change
0199- Nonsub Justification.docx Justification for No Material/Nonsubstantive Change
PHA EVAL Justification of Nonsubstantive Change.docxJustification for No Material/Nonsubstantive Change
PHA EVAL Justification of Nonsubstantive Change.docx Justification for No Material/Nonsubstantive Change
30-Day Notice_02-06-24.pdfSupplementary Document
60-Day PHA Evaluation.pdfSupplementary Document
42 U.S.C. 12639.pdfSupplementary Document
42 U.S.C. 12639.pdf Supplementary Document
EO 13996.pdfSupplementary Document
EO 13996.pdf Supplementary Document
3045-NEW PHA Member Outcome Surveys_SSB_FINAL.docxSupporting Statement B
3045-NEW PHA Member Outcome Surveys_SSB_FINAL.docxSupporting Statement B
3045-NEW PHA Member outcome Surveys_SSA_FINAL.docxSupporting Statement A
3045-NEW PHA Member outcome Surveys_SSA_FINAL.docxSupporting Statement A
Partner Interview Other-Interview Questions
Early Exit Interview Other-Interview Questions
Grantee Focus Group Other-Focus Group Questions
Training and TA Form Form and Instruction
Training and TA Form Form and Instruction
Grantee Survey Form and Instruction
Grantee Survey Form and Instruction
Early Exit Survey Form and Instruction
Early Exit Survey Form and Instruction
Member Alumni Survey Form and Instruction
Member Alumni Survey Form and Instruction

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202503-3045-005 No material or nonsubstantive change to a currently approved collection 2025-03-26 Approved without change
202406-3045-001 No material or nonsubstantive change to a currently approved collection 2024-06-05
202311-3045-001 New collection (Request for a new OMB Control Number) 2024-02-06 Approved with change

OMB Details

Member Alumni Survey

Federal Enterprise Architecture: Community and Social Services - Social Services

Information collection instruments
FormNameElectronic accessType
Form 01Revised Member Alumni Survey and Early Exit Surveywww.americorps.govForm and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.