Information Collection

AmeriCorps State and National Diversity Questionnaire

IC 248995 under ICR 202108-3045-002 · OMB 3045-0193.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0193 can be found here:

Documents and Forms

Document Name Document Type
Form 1 AmeriCorps State and National Diversity Questionnaire Form
1 AmeriCorps State and National Diversity Questionnaire Diversity_Questionnaire_ASN_NOFO_OMB_2021-08-23.xlsx www.nationalservice.gov Form
1 AmeriCorps State and National Diversity Questionnaire Diversity_Questionnaire_ASN_NOFO_OMB_2021-08-23.xlsx www.nationalservice.gov Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	AmeriCorps State and National Diversity Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	AmeriCorps State and National Diversity Questionnaire	Diversity_Questionnaire_ASN_NOFO_OMB_2021-08-23.xlsx	www.nationalservice.gov	Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 750	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	16,928	16,928

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.