View Information Collection Request (ICR) Package
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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:
0420-0564
ICR Reference No:
201706-0420-003
Status:
Historical Active
Previous ICR Reference No:
201705-0420-006
Agency/Subagency:
PEACE
Agency Tracking No:
PC-2143
Title:
Office of Gifts and Grants Management Donation Form
Type of Information Collection:
Existing collection in use without an OMB Control Number
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
11/16/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
06/15/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2020
36 Months From Approved
Responses
13,130
0
0
Time Burden (Hours)
2,188
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
Peace Corps’ Office of Gifts and Grants Management (GGM) uses the information to oversee and manage all private sector donations to the Peace Corps. The type of information collected from potential donors to any of the funds includes name, address, gift amount, payment method and payment information, dedication message, donor intent, status as a returned Peace Corps Volunteer, consent to be listed in the agency’s donor recognition page, consent to share name with Peace Corps Volunteer, and consent to receive information about agency activities and opportunities to donate to or partner with the Peace Corps. Personal information, such as credit card information, is necessary to: a) process donations to the agency, b) respond to donor intent regarding the donation (i.e. dedication message or in honor or in memory of or a restricted gift to support a specific activity or Volunteer community project), c) send donor recognition items, where applicable, and/or, d) send the requisite tax acknowledgement letter.
Authorizing Statute(s):
US Code:
22 USC 2509
Name of Law: Peace Corps Law
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:
79 FR 66755
11/10/2014
30-day Notice:
Federal Register Citation:
Citation Date:
80 FR 15643
03/24/2015
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Call-in Donation Form
PC-2143 C
Call-in Donation Form
Mail-in Donation Form
PC-2143 B
Mail-in Donation form
Online Donation Form
PC-2143 A
Online Donation 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
13,130
0
0
0
-25,870
39,000
Annual Time Burden (Hours)
2,188
0
0
0
-4,313
6,501
Annual Cost Burden (Dollars)
0
0
0
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:
No
Burden Reduction Due to:
Short Statement:
The donation forms have been in use without a control number.
Annual Cost to Federal Government:
$12,340
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
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:
06/15/2017
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