Corporation for National Service EXIT FORM

ICR 200009-3045-001

OMB: 3045-0015

Federal Form Document

Forms and Documents
Document
Name
Status
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC ID
Document
Title
Status
29211
Migrated
ICR Details
3045-0015 200009-3045-001
Historical Active 199805-3045-001
CNCS
Corporation for National Service EXIT FORM
Revision of a currently approved collection   No
Regular
Approved without change 11/27/2000
Retrieve Notice of Action (NOA) 09/28/2000
This information collection request is approved on the conditions agreed to by CNCS in their 11/22/2000 memo. CNCS must provide OMB with a revised copy of the Exit form that reflects the new language requested by the OIG regarding penalties for false statements and certification of hours of service.
  Inventory as of this Action Requested Previously Approved
11/30/2003 11/30/2003 11/30/2000
48,000 0 31,000
5,600 0 5,683
0 0 0

The Corporation for National Service's Exist 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 databse and to indicate their desire to be contacted by organizations after they complete their service.

None
None


No

1
IC Title Form No. Form Name
Corporation for National Service EXIT FORM

  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 48,000 31,000 0 17,000 0 0
Annual Time Burden (Hours) 5,600 5,683 0 -83 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes

$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
09/28/2000


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