OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

AmeriCorps*National Civilian Community Corps Applicant Medical Prescreening Form

ICR 199806-3045-001 · OMB 3045-0025 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
No forms / supporting documents in this ICR. Check IC Document Collections.
IC Document Collections
IC IDCollectionTypeStatusForm
29214 AmeriCorps*National Civilian Community Corps Applicant Medical Prescreening Form Migrated
ICR Details
3045-0025 199806-3045-001
Historical Active 199504-3045-001
CNCS
AmeriCorps*National Civilian Community Corps Applicant Medical Prescreening Form
Revision of a currently approved collection   No
Regular
Approved without change 07/24/1998
Retrieve Notice of Action (NOA) 06/01/1998
Approved as amended by CNCS' memo to OMB of 7/13/98.
  Inventory as of this Action Requested Previously Approved
07/31/2001 07/31/2001 07/31/1998
2,500 0 2,002
1,250 0 1,000
0 0 0
The Applicant Medical Prescreening Form will provide necessary information to assist in the selection process of AmeriCorps*NCCC members so that we do not place an individual into the program with a pre-existing condition or medical history that may endanger their own health or safety of another. Additionally, this form will allow us to make accomodations for Corps members with special needs. Respondents will be 17-24 years old.
None
None
No
1
IC Title Form No. Form Name
AmeriCorps*National Civilian Community Corps Applicant Medical Prescreening Form
  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 2,500 2,002 0 498 0 0
Annual Time Burden (Hours) 1,250 1,000 0 250 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
No
$0
No
No
Uncollected
Uncollected
Uncollected
Uncollected
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
06/01/1998