AmeriCorps Member Application

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0054 can be found here:

Documents and Forms

Document Name Document Type
Form 4 AmeriCorps Member Application Form and Instruction
SEC -618 Americorps Member Application AC Member app Jan 2009.pdf my.americorps.gov/mp/login.do Form and Instruction
2011-1 2011 Member Application AC Member app Jan 2011.pdf www.nationalservice.gov Form and Instruction
3 AmeriCorps Member Application 12.7.12 AC Member App Dec 2012 for OIRA.pdf www.nationalservice.gov Form and Instruction
4 2015 AmeriCorps Member Application Final Cleared AC Member Application 10.6.15.rtf www.nationalservice.gov Form and Instruction
Comments Received Member Application9.23.15.docx Comments IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AmeriCorps Member Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	2015 AmeriCorps Member Application	Final Cleared AC Member Application 10.6.15.rtf	www.nationalservice.gov	Yes	Yes	Fillable Fileable
Form and Instruction	SEC -618	Americorps Member Application	AC Member app Jan 2009.pdf	https://my.americorps.gov/mp/login.do	Yes	Yes	Fillable Fileable
Form and Instruction	2011-1	2011 Member Application	AC Member app Jan 2011.pdf	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable
Form and Instruction	3	AmeriCorps Member Application 12.7.12	AC Member App Dec 2012 for OIRA.pdf	www.nationalservice.gov	Yes	Yes	Fillable Fileable Signable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	225,000	0	225,000
Annual IC Time Burden (Hours)	281,250	-56,250	337,500
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Comments	Comments Received Member Application9.23.15.docx	10/02/2015

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.