Burden and Privacy Statements

February 2024

americorps.gov 1

NCCC Team Leader Application

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average two hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

OMB Control Number 3045-0005

Expiration Date 01/31/2027

NCCC Project Application

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 8.25 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. A response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12612. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0010

Expiration Date 09/30/2025

Voucher and Payment Request Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average five minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12601-12606 and 12639. Purpose - The information requested is collected for the purposes of submitting requests 

for payment. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the information 

for authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice, please 

see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0014

Expiration Date 03/31/2026

Forbearance Request for National Service Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 10 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 
americorps.gov 2

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12601-12606 and 12639.Purpose - The information requested is collected for the purposes of reviewing 

forbearance requests. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the 

information for authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice, 

please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0030

Expiration Date 03/31/2026

AmeriCorps Seniors Grant Applications, Progress Reporting, Independent Living and Respite Surveys

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average one hour per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. A response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 4950 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0035

Expiration Date 09/30/2026

AmeriCorps*VISTA Project Concept Paper, Application Instructions, and Reporting Instructions

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 12.85 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. A response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 4953, 12615, and 12592. Comments on the burden or content of this instrument may be sent to the 

Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the 

collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0038

Expiration Date 5/31/2024

All AmeriCorps Application Instructions: State, National Direct, State Education Award Program, Direct Education Award

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 40 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. A response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0047

Expiration Date 09/30/2026
americorps.gov 3

Interest Payment Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average five minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12601-12606 and 12639.Purpose - The information requested is collected for the purposes of tracking interest 

accrual. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the information for 

authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice CNCS-04-CPOMMR, please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0053

Expiration Date 03/31/2026

AmeriCorps Member Application, Enrollment, and Exit Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 0.75 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY STATEMENT: Authority - 42 U.S.C. 4953, 12592, 12601-12606, 12615, and 12639. Purpose - The primary purpose for collecting this information is to 

successfully enroll a member in a term of service and the education award program. The evaluative information will help CNCS improve its programming and 

services to members. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the 

information for authorized purposes under the national service laws. Additionally, CNCS may share the information with other agencies, such as the Social 

Security Administration, through computer matching agreements for the purpose of verifying identity and citizenship status information provided by you in this 

document, as well as other matching and data sharing agreements with federal agencies, agency contractors, and other non-federal entities to assist the 

agency in its research and statistical evaluation missions. In some cases, the information may also be provided to federal, state, and local law enforcement 

agencies to determine the existence of any prior criminal convictions or as specified in the routine uses stated in the published System of Records Notice. For a 

complete description of routine uses published in the System of Records Notice, please see: Privacy Policy | AmeriCorps. Disclosure - Your Social Security Number 

(SSN) is solicited under the authority of the Internal Revenue Code (26 U.S.C. 6011(b) and 6109) for use as a taxpayer identification number. While disclosure of 

your information, including your SSN, is voluntary, failure to disclose your SSN may result in a denial of the Segal AmeriCorps Education Award.

OMB Control Number 3045-0054

Expiration Date 4/30/2025
americorps.gov 4

President’s Volunteer Service Award

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 33 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0086

Expiration Date 09/30/2026

External Reviewer Application Instructions

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 45 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C 12585(d). Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0090

Expiration Date 05/31/2026

Member Feedback Survey

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 15 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 5001, 12585, and 12651d.The information requested in the Peer Reviewer Application Instructions is collected 

pursuant to 42 U.S.C. 12592 and 12615 of the National and Community Service Act of 1990 as amended, and 42 U.S.C. 4953 of the Domestic Volunteer Service 

Act of 1973 as amended, and 42 U.S.C. 12639. Purpose - The information requested is collected for the purposes of reviewing applications to be peer 

reviewers. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the information for 

authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice, please see: Privacy

Policy | AmeriCorps. Disclosure – Your Social Security Number (SSN) is solicited under the authority of the Internal Revenue Code (26 U.S.C. 6011(b) and 6109) for 

use as a taxpayer identification number. While disclosure of your information including your SSN, is voluntary, failure to disclose your SSN may result in a denial 

of your application to serve as a peer reviewer.

OMB Control Number 3045-0094

Expiration Date 5/31/2024
americorps.gov 5

Commission Support Grants

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 37 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12638. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0099

Expiration Date 2/29/2024

Financial Management Survey Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average two hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12612. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0102

Expiration Date 9/30/2024

Serve.gov Project and Volunteer Registration 

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 10 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12653 and 12639. Purpose - The information requested is collected for the purposes of connecting members of the 

public with volunteer opportunities. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who 

need the information for authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records 

Notice, please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0122

Expiration Date 3/31/2025

CNCS Disaster Response Cooperative Agreements

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average two hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 5121-5206, 12651g(b). Comments on the burden or content of this instrument may be sent to the 
americorps.gov 6

Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the 

collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0133

Expiration Date 4/30/2024

Education Award Transfer Forms

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average five minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12601-12606 and 12639. Purpose - The information requested is collected for the purpose of managing requests to 

transfer the Segal Education Award. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who 

need the information for authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records 

Notice, please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0136

Expiration Date 08/31/2026

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average ten minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0137

Expiration Date 05/31/2026

Current Population Survey: Civic Engagement Supplement

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 6.67 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 4955, 12594, 12618, and 12639. Purpose - The information requested is collected for the purposes of research on 

civic engagement. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the 
americorps.gov 7

information for authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice, 

please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0139

Expiration Date 08/31/2026

Childcare Application

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 35 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 4955, 12594, 12618, and 12639. Purpose - The information requested is collected for the purposes of providing 

childcare for AmeriCorps members. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who 

need the information for authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records 

Notice, please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0142

Expiration Date 03/31/2025

Segal Education Award Matching Commitment Form 

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 30 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0143

Expiration Date 3/31/2025

National Service Criminal History Checks Recordkeeping Requirement

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 2.25 hours per grantee to comply with the recordkeeping 

requirements associated with criminal history checks and reviewing the collection of information. Response to this information collection is required to obtain 

or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for National and 

Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control 

number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0150

Expiration Date 08/31/2025
americorps.gov 8

Generic Clearance for Pilots, Tests, Focus Groups, Demonstrations

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average two minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0163

Expiration Date 4/30/2024

Employers of National Service Enrollment Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 25 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12639, 12651d, and 12653. Purpose - The principal purpose for requesting this personal information is to process 

your application to enroll as an Employer of National Service. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, 

and other individuals who need the information for authorized purposes under the national service laws. For a complete description of routine uses published 

in the System of Records Notice, please see: Privacy Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0175

Expiration Date 9/30/2024

AmeriCorps State and National Disability Accommodation Request Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average nine minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority -. 42 U.S.C. 12592, 12639, 12651d, and 12653 Purpose - This form is used for AmeriCorps State and National programs that 

request reimbursement for funds spent to accommodate one or more members with disabilities. Because a member may be sensitive about the request to 

disclose their need or reason for an accommodation, the information requested on this form, which might identify the member, should only be used and 

disclosed to process this reimbursement request, for aggregate reporting, and other crucial reasons which are legally permitted. Routine Uses – The 

information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the information for authorized purposes under the 

national service laws. For a complete description of routine uses published in the System of Records Notice, please see: Privacy Policy | AmeriCorps. Disclosure –

The information collection is voluntary.
americorps.gov 9

OMB Control Number 3045-0179

Expiration Date 03/31/2026

Day of Service Application Form

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 20 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12639, 12651d, and 12653. Purpose - The information requested is collected for the purpose of assessing outcomes 

of service. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the information for 

authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice, please see: Privacy

Policy | AmeriCorps. Disclosure – The information collection is voluntary

OMB Control Number 3045-0180

Expiration Date 03/31/2026

NCCC Member Experience Survey

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 15 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Comments on the burden or content of this 

instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not 

required to respond to the collection unless the OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 

1320.5(b)(2)(i).) 

PRIVACY ACT NOTICE: Authority - 42 U.S.C. 12639, 12651d, and 12653. Purpose - The information requested is collected for the purpose of assessing outcomes 

of service. Routine Uses – The information you provide will be disclosed to CNCS employees, contractors, and other individuals who need the information for 

authorized purposes under the national service laws. For a complete description of routine uses published in the System of Records Notice, please see: Privacy

Policy | AmeriCorps. Disclosure – The information collection is voluntary.

OMB Control Number 3045-0181

Expiration Date 03/31/2026

AmeriCorps State and National Grantee Progress Report

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 10 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 
americorps.gov 10

OMB Control Number 3045-0184

Expiration Date 12/31/2025

AmeriCorps Grant Application

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 40 hours per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0187

Expiration Date 12/31/2025

NCCC Project Sponsor Survey

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 20 minutes per submission, including reviewing instructions, 

gathering and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

required to obtain or retain benefits under 42 U.S.C. 12501 et seq. Comments on the burden or content of this instrument may be sent to the Corporation for 

National and Community Service, Attn: Amy Borgstrom, 250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the 

OMB control number and expiration date displayed on page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0190

Expiration Date 03/31/2026

External Reviewer Survey

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 15 minutes per submission, including reviewing instructions, 

gathering, and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service, Attn: Amy Borgstrom, 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) 

OMB Control Number 3045-0192

Expiration Date 3/31/2024

AmeriCorps Program Life Cycle Evaluation—Opioid Recovery Coach Model Bundled Evaluation

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 31 minutes per submission, including reviewing instructions, 

gathering, and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service Attn: Amy Borgstrom 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) i).) 
americorps.gov 11

OMB Control Number 3045-0194

Expiration Date 10/31/2024

AmeriCorps Program Life Cycle Evaluation—Volunteer Generation Fund Grant Program Evaluation

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 25 minutes per submission, including reviewing instructions, 

gathering, and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service Attn: Amy Borgstrom 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) i).) 

OMB Control Number 3045-0195

Expiration Date 11/30/2024

AmeriCorps Program Life Cycle Evaluation - Climate Change

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average 23 minutes per submission, including reviewing instructions, 

gathering, and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service Attn: Amy Borgstrom 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) i).) 

OMB Control Number 3045-0197 

Expiration Date 02/28/2026

AmeriCorps All-Partner Training and TA Survey

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average eight minutes per submission, including reviewing instructions, 

gathering, and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service Attn: Amy Borgstrom 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) i).) 

OMB Control Number 3045-0198 

Expiration Date 03/31/2026

Vaccine Attestation Form for Contractors

PUBLIC BURDEN STATEMENT: Public reporting burden for this collection is estimated to average two minutes per submission, including reviewing instructions, 

gathering, and maintaining the data needed, completing the form, and reviewing the collection of information. Response to this information collection is 

voluntary. Comments on the burden or content of this instrument may be sent to the Corporation for National and Community Service Attn: Amy Borgstrom 

250 E. Street SW, Washington, D.C. 20525. You are not required to respond to the collection unless the OMB control number and expiration date displayed on 

page 1 are current and valid. (See 5 C.F.R. 1320.5(b)(2)(i).) i).) 
americorps.gov 12

OMB Control Number 3206-0277

Expiration Date 5/31/2025