OMB 0420-0006-Confidential Ref Form supporting statements

Peace Corps – Office of Volunteer Recruitment and Selection

Peace Cops Confidential Reference Form PC-1532

OMB Control Number 0420-0006

Supporting Statement

Section A: Justification

1. The Peace Crops Act (22 USC2501 et seq.) authorizes the recruitment of persons for service in the Peace Corps Volunteer programs.

2. The Office of Volunteer Recruitment and selection will be responsible or administration of the Reference Forms. The Peace Crops Volunteer Reference Form is used to gather information about individuals who have submitted applications, are basically qualified, and are nominees for Volunteer service. The form is an integral part of the screening and selection process conducted by the Office of Volunteer Recruitment and Selection. Such information as past criminal records, severe mental problems, poor interpersonal relationships or emotional immaturity is used by the agency in their consideration of applicants. There is no other means of obtaining the required data.

3. Peace Crops is unaware of any information technology that would provide an applicant’s potential for Volunteer service overseas.

4. The information requested does not exist in agency records.

5. The collection of information does not involve small business or other small entities

6. Failure to collect this information would hinder the mission of the Office of Volunteer Recruitment and Selection and the mission of the agency.

7. No special circumstances exist that require the collection to be conducted in a manner inconsistent with the guidelines in 5 CFR Subsection 1320.6.

9. No payment or gift is provided to respondents.

Peace Corps – Office of Volunteer Recruitment and Selection

Peace Cops Confidential Reference Fro PC-1532

OMB Control Number 0420-0006

Supporting Statement

Section A: Justification

10. Respondents are informed that the Privacy Act provides that Peace Crops may keep their identity confidential, if so requested. The form has a box to check if the individual does not authorize the Peace Crops to identify the respondent as the source. The form also has a box to check indicating that the individual authorizes the Peace Crops to identify the respondent as the source.

The following is agency policy in responding to Privacy Act requests from individuals for copies for references:

• If one or more person in the group request confidentiality, no copies of the references are released. Since the individual provides the names of the references they could determine who requested confidentiality. A reference summary is released with generic information, nothing identifiable. Appeal rights are provided.

• If no one requests confidentiality, copies of all the references are released.

The privacy Act notices is printed on the form for assurance of confidentiality. It reads:

(taken from the back of the Reference Form)

The Privacy Act is a federal law that states that everyone has the right to know about and receive information about, or copies of, documents about them that are maintained by the federal government. This law provides that the Peace Corps may keep the identity of the source of this reference confidential only if you request that it be kept confidential. Please indicate below whether you do or do not wish your identity reveled to the applicant.

□ I DO NOT authorize the Peace Corps to identify me as the source of this reference, nor do I authorize the Peace Crops to release a copy of this reference in its entirety to the applicant, I realize that a summary of this reference may be released without my approval.

□ I AUTHORIZE the Peace Crops to identify me as the source of this reference and to release a copy of this reference, upon request, to the applicant.

11. No questions of a sensitive nature are asked.

Peace Corps – Office of Volunteer Recruitment and Selection

Peace Cops Confidential Reference Fro PC-1532

OMB Control Number 0420-0006

Supporting Statement

Section A: Justification

12. a. Estimated Number of respondents: 33,000

b. Frequency of response: one time

c. Completion time: 30 minutes

d. Annual burden hours: 16,500

13. Cost to respondents based on one-half hour of annual salary equivalent to FP5/1 ($47,576)=$22.79/hr=$11.40 for one-half hour.

Other costs limited to cost of postage for 1-ounce letter; envelope provided by agency

14. Cost to Federal Government

Printing $1,000

Mailing of references and return postage $17,900

Analyzing information and processing

(43% of six evaluator’s time at an average grade equivalent

of FP7/1 ($38,022)) $98,097

Administrative costs $17,491

(Clerical handling, filing mailing, opening and delivering to staff, retention and retirement, Peace Corps Placement Staff review)

Total $134,488

15. There have only been format changes since the last submission

16. This information will not be published for statistical use.

17. N/A

17. N/A

Section B. collections of Information Employing Statistical Methods

This collection of information does not employ statistical methods.

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