Generic Information Collection Request for Test and Pilot Data

Forms and Documents

Document Name	Status
Form 1 AmeriCorps Symposium Evaluation Form	New
Form 1 Organizational Capacity Assessment Form and Instruction	New
Form 1 Community Conversations Pilot Form and Instruction	New
Form 1 Alumni Outcomes Pilot Survey Form and Instruction	New
Form 1 AmeriCorps Opportunity Youth Evaluation Bundling Pilot Form and Instruction	New
Form 1 Pilot Test of AmeriCorps Alumni Outcomes Survey Form and Instruction	New
Generic for Pilots Clearance Template Part B 6.9.2014.doc Supporting Statement B	2014-06-18
SSA Generic for Pilots_Rev 10.22.14.docx Supporting Statement A	2014-10-23

IC Document Collections

IC ID	Document Title	Status
227315	AmeriCorps Symposium Evaluation Form	New
226641	Organizational Capacity Assessment Form and Instruction	New
221771	Community Conversations Pilot Form and Instruction	New
219510	Alumni Outcomes Pilot Survey Form and Instruction	New
214945	AmeriCorps Opportunity Youth Evaluation Bundling Pilot Form and Instruction	New
214035	Pilot Test of AmeriCorps Alumni Outcomes Survey Form and Instruction	New

ICR Details

OMB Control No: 3045-0163	ICR Reference No: 201406-3045-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: CNCS	Agency Tracking No:
Title: Generic Information Collection Request for Test and Pilot Data
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/23/2014
	Date Received in OIRA: 06/18/2014
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2017	36 Months From Approved
Responses	10,500	0	0
Time Burden (Hours)	350	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a new information collection. The information collection activity will enable pilot testing of survey instruments in an efficient, timely manner, in accordance with the Administration's commitment to improving service delivery. By pilot testing we mean information that provides useful insights on how respondents interact with the instrument, but are not statistical surveys that yield quantitative results that can be generalized to the population of study. This feedback will provide insights into customer or stakeholder perceptions, experiences and expectations regarding prospective studies. It will also allow feedback to contribute directly to the improvement of research program management.

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Authorizing Statute(s): US Code: 42 USC 12501 et seq Name of Law: National Community Service act of 1995 as amended
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 12495	03/05/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 34723	06/18/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Pilot Test of AmeriCorps Alumni Outcomes Survey	1	Pilot Alumni Survey
Organizational Capacity Assessment	1	Organizational Capacity Assessment Instrument
AmeriCorps Symposium Evaluation	1	AmeriCorps Symposium Evaluation Questions
AmeriCorps Opportunity Youth Evaluation Bundling Pilot	1	Bundling Survey Communications Pilot Test
Community Conversations Pilot	1	Questions for Community Conversations Pilot
Alumni Outcomes Pilot Survey	1	Alumni Outcome Survey

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ICR Summary of Burden

	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	10,500	0	0	10,500	0	0
Annual Time Burden (Hours)	350	0	0	350	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: The burden has increased because this is a new generic information collection.

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? 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? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 06/18/2014

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