Information Collection

Segal Education Award Matching Program Commitment Form

IC 202529 under ICR 202201-3045-002 · OMB 3045-0143.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3045-0143 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Segal Education Award Matching Program Commitment Form Form and Instruction
1 Ed Award Commitment Matching Form Segal Award Matching Program Commitment Form_V6 5.docx www.nationalservice.gov Form and Instruction
1 Ed Award Commitment Matching Form Segal Award Matching Program Commitment Form_V6 5.docx www.nationalservice.gov Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Segal Education Award Matching Program Commitment Form	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	1	Ed Award Commitment Matching Form	Segal Award Matching Program Commitment Form_V6 5.docx	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: 200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	200	0	200
Annual IC Time Burden (Hours)	100	0	100
Annual IC Cost Burden (Dollars)	4,514	4,514	0

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.