Information Collection

AmeriCorps*National Civilian Community Corps Applicant Medical Prescreening Form

IC 29214 under ICR 199806-3045-001 · OMB 3045-0025.

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Information Collection (IC) Details

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IC Title:	AmeriCorps*National Civilian Community Corps Applicant Medical Prescreening Form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Migrated

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

Line of Business:

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,500	498	2,002
Annual IC Time Burden (Hours)	1,250	250	1,000
Annual IC Cost Burden (Dollars)	0	0	0

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