Peace Corps Response Interview Assessment Form

Forms and Documents

Document Name	Status
Form PC-2135 Peace Corps Response Interview Assessment Form Form and Instruction	Modified
Supporting Statement-PCR Interview Asessment-Final 11-2.docx Supporting Statement A	2017-11-14

IC Document Collections

IC ID	Document Title	Status
214707	Peace Corps Response Interview Assessment Form Form and Instruction	Modified

ICR Details

OMB Control No: 0420-0556	ICR Reference No: 201709-0420-006
Status: Historical Active	Previous ICR Reference No: 201501-0420-001
Agency/Subagency: PEACE	Agency Tracking No: PC-2135
Title: Peace Corps Response Interview Assessment Form
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/14/2017
	Date Received in OIRA: 09/26/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2020	36 Months From Approved	03/31/2018
Responses	1,000	0	700
Time Burden (Hours)	1,000	0	700
Cost Burden (Dollars)	0	0	0

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Abstract: The Peace Coorps Response Interview is necessary to assess applicants' qualifications and eligibility to serve in Peace Corps Response. the interview is a critical point in the recruitment process, as it is the point whenthe applicant and the recruitment and placement specilaist verbally discuss the nature of the Volunteer assignment.

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Authorizing Statute(s): None

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:
	82 FR 32208	07/12/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 43576	09/18/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Peace Corps Response Interview Assessment Form	PC-2135	Peace Corps Response Interview Assessment Form

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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	1,000	700	0	300	0	0
Annual Time Burden (Hours)	1,000	700	0	300	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 ICR increased because of program change due to Agency discretion.

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Annual Cost to Federal Government: $31,946

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

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: 09/26/2017

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