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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
3045-0015
ICR Reference No:
200704-3045-005
Status:
Historical Active
Previous ICR Reference No:
200402-3045-005
Agency/Subagency:
CNCS
Agency Tracking No:
Title:
Corporation for National Service EXIT FORM
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved without change
Conclusion Date:
07/17/2007
Retrieve Notice of Action (NOA)
Date Received in OIRA:
04/30/2007
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
07/31/2010
36 Months From Approved
07/31/2007
Responses
146,000
0
50,000
Time Burden (Hours)
8,517
0
5,833
Cost Burden (Dollars)
0
0
0
Abstract:
The Corporation for National Service's Exit Form is used by AmeriCorps programs to provide information regarding an AmeriCorps member's term of national service. The form is used by a member's program to indicate whether the member is eligible for an education award. Members use the form to update their addresses in the Corporation's database and to indicate their desire to be contacted by organizations after they complete their service.
Authorizing Statute(s):
US Code:
42 USC 12594
Name of Law: National Service Act
US Code:
42 USC 12639
Name of Law: National Service Act
US Code:
42 USC 12501
Name of Law: National Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
72 FR 4242
01/30/2007
30-day Notice:
Federal Register Citation:
Citation Date:
72 FR 19182
04/17/2007
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
1
IC Title
Form No.
Form Name
Corporation for National Service EXIT FORM
3045-0015
MeMber Exit Form
ICR Summary of Burden
Total Approved
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
146,000
50,000
0
96,000
0
0
Annual Time Burden (Hours)
8,517
5,833
0
2,684
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:
No
Burden Reduction Due to:
Short Statement:
We have re-evaluated the burden and more members will be enrolled in the program. Also, after a member complete their portion of the form, the local organization completes the second portion.
Annual Cost to Federal Government:
$0
Does this IC contain surveys, censuses, or employ statistical methods?
No
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
Uncollected
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Kevin Cramer 202-606-6632 kcramer@cns.gov
Common Form ICR:
No
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:
04/30/2007
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