View Information Collection Request (ICR) Package

View ICR - Agency Submission

OMB Control No:	ICR Reference No: 202608-3045-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: CNCS	Agency Tracking No:
Title: AmeriCorps VISTA Criminal History Acknowledgement Form
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR: No
Type of Review Request: Regular	Date Submitted to OIRA: 10/14/2026

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	240	0
Time Burden (Hours)	120	0
Cost Burden (Dollars)	8,064	0

ICR Summary of Burden

	Total Request	Change Due to Agency Discretion
Annual Number of Responses	240	240
Annual Time Burden (Hours)	120	120
Annual Cost Burden (Dollars)	8,064	8,064

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: This is a new form that will increase sponsors’ autonomy in selecting VISTA volunteers and that standardizes data collection for more efficient workflow and prompt adjudication of criminal history issues.

Annual Cost to Federal Government: $3,857

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. No

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: Elizabeth Appel 202 273-4680 elizabeth.appel@bia.gov

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