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Member Alumni Survey
Evaluation of Public Health AmeriCorps
OMB: 3045-0199
IC ID: 264738
OMB.report
CNCS
OMB 3045-0199
ICR 202503-3045-005
IC 264738
( )
Documents and Forms
Document Name
Document Type
Form 01
Member Alumni Survey
Form and Instruction
Form 01
Member Alumni Survey
Form and Instruction
01 Revised Member Alumni Survey and Early Exit Survey
0199 - Member Alumni Survey_EDITED-Clean.docx
www.americorps.gov
Form and Instruction
01 Revised Member Alumni Survey and Early Exit Survey
0199 - Member Alumni Survey_EDITED-Clean.docx
www.americorps.gov
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Member Alumni Survey
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
01
Revised Member Alumni Survey and Early Exit Survey
0199 - Member Alumni Survey_EDITED-Clean.docx
www.americorps.gov
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Social Services
Privacy Act System of Records
Title:
CNCS-04-CPO-MMF Member Management Files
FR Citation:
85 FR 3896
Number of Respondents:
1,562
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
1,562
0
0
0
0
1,562
Annual IC Time Burden (Hours)
1,562
0
0
0
0
1,562
Annual IC Cost Burden (Dollars)
73,976
0
0
0
0
73,976
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.