Supporting Statement 0420-0006

Section A: Justification
1. Peace Corps uses the confidential reference form in order to learn from someone, who
knows a volunteer applicant and his or her background, whether the applicant possesses
the necessary characteristics and skills to serve as a Volunteer. See 22 CFR 305.4
(eligibility and selection standards for Peace Corps volunteer service.)
2. The Recruitment and Placement teams in the Office of Volunteer Recruitment and
Selection use the Confidential Reference Form as an integral part of the screening and
selection process to determine whether an applicant is likely to succeed as a Peace Corps
volunteer.
3. Peace Corps includes the Confidential Reference Form in its web-based application
process. Applicants may send the Confidential Reference Form to their references
electronically via the website. References may return the form electronically via the web
service. Hard-copies are made available upon request in order to ensure equal availability
of the form to those without computer capabilities. When an applicant requests that
Peace Corps send hard copy Confidential Reference Forms, Peace Corps provides the
references with postage-paid envelopes.
4. Information, from people familiar with an applicant’s skills and characteristics is
available nowhere else. In cases where an applicant has reapplied to serve as a Volunteer
(either to serve an additional term, or because the applicant was not selected previously
for any reason), the Placement and Recruitment staff can refer back to the references
already on file, if the prior application is less than two years old and the application has
remained active. Peace Corps requires that an applicant provide new references if the
prior references are more than two years old, or if the file has become inactive. A file
would become inactive (even if it is less than two years old) if the applicant voluntarily
withdrew or if the applicant was given a temporary rejection by a recruiter due, for
example to a lack of skills or work experience.
5. The collection of information from the Peace Corps Confidential Reference Form does
not impact small businesses or other small entities.
6. If Peace Corps were unable to collect the reference information requested on this form,
the agency would run the risk of sending poorly qualified or unqualified representatives
into foreign countries. The communities where Peace Corps assigns Volunteers often
observe closely the actions and behaviors of Volunteers, who are representatives of the
United States. A Volunteer with poor performance, bad judgment, social inadequacy, or
undesirable personal behavior easily may become an embarrassment to the United States.
A poorly screened volunteer may create conflict and embarrassment for the United States
by attracting negative media or political attention.

7. Peace Corps asks, but does not require, the applicant’s reference to return the form within
7 days in order to benefit the applicant. Returning the form within 7 days allows Peace
Corps to expedite an applicant’s qualification and suitability review.
8. The agency’s notice was published in the Federal Register on August 20, 2010, 75 Fed.
Reg. 51502 (August 20, 2010). No public comments were received during the 60-day
period.
9. No payment or gift is provided to respondents.
10. Respondents are informed that the Privacy Act, 5 U.S.C. § 552a(k)(5), provides that
Peace Corps may keep their identity confidential, if so requested. The form has a box to
check if the respondent does not authorize the Peace Corps to identify him or her as the
source of the reference. The form also has a box to check indicating that the respondent
authorizes the Peace Corps to identify the respondent as the source.
The agency’s policy for responding to Privacy Act requests from individuals for copies
for references is as follows:
a. If one or more person in the group of an applicant’s references requests
confidentiality, no copies of the references are released. Since the applicants
provide the names of the references, the applicants could determine who
requested confidentiality. A reference summary is released with generic
information, nothing identifiable. Appeal rights are provided.
b. If requested, copies of all the references are released, but only if no one has
requested confidentiality.
Privacy Act notices are printed on the form for assurance of confidentiality. It reads:
(taken from 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 Corps 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 Corps 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.

12.

Estimated burden (hours) of the collection of information:
a. Average Number of Annual Applicants
(complete the application process):
b. Number of reference required per applicant:
c. Estimated Number of reference forms received:
d. Frequency of response:
e. Completion time:
f. Annual burden hours:
g. Number of forms received electronically (97%):
h. Number of forms received hardcopy (3%)
PRA Violation:
Change Due to Adjustment in Agency Estimate:
Annual Number of Responses
Annual Time Burden (Hr)
Previously approved burden
Annual Number of Responses
Annual Time Burden (Hr)
Total change due to PRA violation
Annual Number of Responses
Annual Time Burden (Hr)

B.

13,400
3
40,200
One time
30 minutes
20,100
38,994
1,206

12480
6240
27720
13860
40,200
20,100

There should be no cost to respondents.

13.

There is no total annual cost burden to respondents or record keepers.

14.

Total annual cost to the Federal Government per annum (3% of 40,200 forms)
Printing
(includes cost of paper, ink, printing labor)

$

975

Mailing out of form to references
($0.44 (postage cost) x 1,206 (#of mailings)

$

531

Return postage costs
($0.44 (postage cost) x 1,206 (#of mailings)

$

531

Analyzing information and processing
(see table below for calculation of labor hours)

$ 103,556

TOTAL per annum

$ 105,593

Number of reference forms reviewed in Interview Phase by a Recruiter
(13,400 completed applications x 3 reference forms each / 88 Recruiters)
Average amount of time a Recruiter reviews reference forms
(457 forms x 3 minutes per form / 60 minutes)

457

23 hours

Labor cost for review by all Recruiter
(23 hours / 2087 hours per year = 0.01 of a Recruiters’ annual salary
0.01 of a Recruiters’ salary x $53,350 annual salary of a Recruiter
$534 x 88 Recruiters)

$46992

Number of applications moved to Placement Assistants for Nomination
(65% x 13,400 applications)

8710

Amount of time a Placement Assistant screens reference forms
(8710 applicants x 3 references each / 10 Placement Assistants
2613 reference forms x 2 minutes per form / 60 minutes)

87 hours

Labor cost for screening by Placement Assistants (PAs)
(87 hrs / 2087 hrs per year = 0.04 of a PAs’ annual salary
0.04 of a PAs’ annual salary x $42,637 annual salary of a PA
$1706 x 10 PAs)

$17,060

Amount of time a Placement Officer follow up with references (if needed)104 hours
(5% of annual labor hours x 2087 hrs = 104 hrs)
Labor cost for follow up with references by Placement Officers (POs)
(104 hrs / 2087 hrs = 0.05 annual salary of a PO
0.05 of a PO annual salary x 65,840 annual salary of a PO
$3292 x 12 POs)

TOTAL LABOR HOURS

$39,504

$103,556

15.

Due to an increasing number of volunteer applicants; the number of reference forms sent
out has increased. The annual burden hour has also increased in correlation to the
increase in references.

16.

This information will not be published.

17.

N/A

18.

A.

The agency is able to certify compliance with all provisions under Item 19 of
OMB Form 83-I.

Section B: Collection of Information Employing Statistical Methods
The collection of information does not employ statistical methods.