View Information Collection Request (ICR) Package

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 Generic ICR - OIRA Conclusion

OMB Control No: 0420-0006	ICR Reference No: 201705-0420-001
Status: Historical Active	Previous ICR Reference No: 201510-0420-003
Agency/Subagency: PEACE	Agency Tracking No: PC-1532
Title: Peace Corps Confidential Reference Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR: No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 08/31/2017
	Date Received in OIRA: 05/16/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2020	36 Months From Approved	03/31/2018
Responses	18,000	0	40,000
Time Burden (Hours)	3,000	0	6,667
Cost Burden (Dollars)	0	0	0

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to Agency Discretion
Annual Number of Responses	18,000	40,000	-22,000
Annual Time Burden (Hours)	3,000	6,667	-3,667
Annual Cost Burden (Dollars)	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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

Burden Reduction Due to: Using Information Technology

Short Statement: The reference form employs the use of information technology to make the collection of the data electronic, reducing time for references and the use of agency resources. The use of a standardized, automated electronic form improves the quality of the information collected by ensuring that the same information is received from all references. It also ensures the confidentiality of the content, as the reference submits the form directly to the Peace Corps, and not through the applicant.

Annual Cost to Federal Government: $15,000

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? Uncollected

Agency Contact: Denora Miller 202 692-1236 dmiller4@peacecorps.gov

Something went wrong when downloading this file. If you have any questions, please send an email to risc@gsa.gov.