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OMB Control No: 3060-1298	ICR Reference No: 202201-3060-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: FCC	Agency Tracking No: OMD-IO
Title: Volunteer Service Agreement Form
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR: No
Type of Review Request: Emergency	Approval Requested By: 01/19/2022
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/19/2022
	Date Received in OIRA: 01/14/2022
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2022	6 Months From Approved
Responses	25	0	0
Time Burden (Hours)	6	0	0
Cost Burden (Dollars)	0	0	0

Abstract: The Volunteer Service Agreement Form is currently used by the FCC to identify individuals seeking to participate in a volunteer service program administered by the agency and determine their eligibility for such service. In addition, the form is being revised to now require individuals seeking volunteer positions to certify that they comply with COVID-19 vaccine requirements for Federal workers as set forth by Executive Order 14043 and other mandates.

Emergency Justfication: The Federal Communications Commission (Commission or FCC) requests Office of Management and Budget (OMB) approval to submit the information collection described herein under the “emergency processing” provisions of the Paperwork Reduction Act (PRA) of 1995, 5 CFR 1320.13. The Commission is requesting clearance for a new information collection entitled [3060-XXXX], Volunteer Service Agreement, FCC Form A-384. For the reasons explained below, We respectfully request OMB approval for this new information collection at the earliest possible time. To ensure compliance with this mandate, the FCC is requiring all employees to complete and submit a form attesting to their current vaccination status. For volunteer workers, the FCC is choosing to require applicants to certify as to their vaccination status when applying for a position as part of the agency’s existing Volunteer Service Agreement form. However, the FCC is required to obtain OMB approval prior to collecting such information. Moreover, the FCC recently discovered that although its Volunteer Service Agreement form has been used to collect basic identifying information about volunteer applicants for approximately a decade, PRA approval was never sought for the use of this form. Emergency processing is being sought so that the FCC can continue to process volunteer service requests while it seeks approval for use of the existing portion of the form without a lengthy disruption.

Authorizing Statute(s): EO: EO 14043 Name/Subject of EO: Protecting the Federal Workforce and Requiring Mask-Wearing
US Code: 5 USC 3111 Name of Law: Acceptance of Volunteer Service

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
Did the Agency receive public comments on this ICR? No

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Individuals or Households	FCC Form A-384

ICR Summary of Burden

	Total Approved	Change Due to Agency Discretion
Annual Number of Responses	25	25
Annual Time Burden (Hours)	6	6
Annual Cost Burden (Dollars)	0	0

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

Burden Increase Due to: Changing Regulations

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

Burden Reduction Due to:

Short Statement: This is a new information collection resulting in a program change/increase of 25 respondents, 25 responses, and 6 total estimated burden hours.

Annual Cost to Federal Government: $0

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? No

Agency Contact: Warren Firschein 202 418-0844 Warren.Firschein@fcc.gov

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