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Corporation for National and Community Service (AmeriCorps)

AmeriCorps Member Application, Enrollment in National Trust, and Exit Forms

OMB Control Number 3045-0054

Justification – Part A Supporting Statement

Overview of Information Collection:

This information collection consists of the AmeriCorps Member Application, Enrollment in National Trust, and Exit Forms. The Member Application Form is used by applicants who are interested in serving as AmeriCorps members. The information requested in the application form makes it possible for programs to select members to serve. AmeriCorps program offices also use this form as an example that they customize to develop their own recruitment materials. The Enrollment Form is used by AmeriCorps members and program staff to enroll members in the National Service Trust. The Exit Form is used by AmeriCorps members and program staff to document the completion of members’ term of service.

• This is a Revision to an Existing Collection. AmeriCorps also seeks to continue using the currently approved information collection until the revised information collection is approved by OMB. The currently approved information collection is due to expire on April 30, 2025.

• The forms used for this collection are the AmeriCorps Member Application, which is completed by individuals seeking to become an AmeriCorps member, and Enrollment in National Trust and Exit forms, which are completed by AmeriCorps members at the end of their term of service.

• Changes to the Application form include:

  • On the National Service Trust Exit form, an updated “Privacy Act Information Release” question that gives members the option to allow AmeriCorps to share the member’s contact information with the Selective Service System, the Peace Corps, and the Department of Defense, in addition to the option to share with the AmeriCorps Alumni Association.

  • On the National Service Trust Enrollment form and Exit form, replacement of the “AmeriCorps Affiliate” and “Half-time (900 hours in no more than 2 years)” options with an “Other” option, to better capture all possible types of enrollment.

  • Updates to AmeriCorps’ physical address.

  • Replacement of “gender” with “sex” and deletion of the options beyond “male” and “female.”

• Burden estimates increased overall to account for the Enrollment and Exit forms, but the hourly burden associated with the previously approved Application decreased to account for automated processes.

1. Need & Method for the Information Collection.

The Domestic Volunteer Service Act of 1973, as amended, (DVSA), 42 U.S.C. 4950 et seq., and the National and Community Service Act of 1990, as amended, (NCSA) 42 U.S.C. 12501 et seq., authorize this collection of information. Specifically, Section 4953(b)(3) of DVSA and Section 12592 of the NCSA addresses the selection process for individuals to serve in AmeriCorps programs and section 12604(c)(1) addresses enrollment in the National Service Trust. These statutes do not impose any deadlines. This information is collected electronically using the AmeriCorps secure portal and in a fillable PDF form. If respondents are unable to apply or report on-line, they can use the hard copy form and instruction to submit their application. The information collection is managed by the Office of Program Operations and self-administered. This information collection is necessary to collect information about people who apply to Enroll and Exit from AmeriCorps programs. Without this information collection, AmeriCorps cannot and provide information about who is enrolling and cannot enroll member into the National Service Trust.

2. Use of the Information.

The AmeriCorps Member Application, Enrollment and Exit form collects information on potential members and existing members. These forms allow AmeriCorps to collect eligibility information about people seeking to serve as an AmeriCorps member, collects member enrollment information for program sites, and information from members exiting AmeriCorps programs about their post service plans and enrolls exiting members in the National Service Trust. This information is not used by other federal agencies.

3. Use of Information Technology.

AmeriCorps will be eliciting and accepting applicants’ response to these questions electronically via eGrants, the AmeriCorps’ secure online grants management system, or via a fillable PDF form. If applicants or members are unable to apply/enroll/exit on-line, they can use the hard copy forms and to complete their application, enrollment or exit form.

4. Non-duplication.

This information is not collected elsewhere and there are no other sources of information by which AmeriCorps can meet the purposes described above.

 

5. Burden on Small Business.

This collection of information does not impact small businesses because they are not eligible to apply for grants. There is no economic burden to any other small entities beyond the cost of staff time to collect and report the data. This is minimized to the degree possible by only asking for the information necessary to understand who is applying, enrolling in, and exiting from AmeriCorps programs.

6. Less Frequent Collection.

If AmeriCorps does not collect this information or collects it less frequently, AmeriCorps will be unable to determine program eligibility, provide important demographical information about applicants and members enrolling or exiting service, or enroll exiting members into the National Service Trust.

7. Paperwork Reduction Act Guidelines.

There are no special circumstances that would require the collection of information in any way that would violate Paperwork Reduction Act guidelines.

8. Consultation and Public Comments.

The 60-day Notice soliciting comments was published in the Federal Register on December 30, 2024, at 89 FR 106447. No comments were received. Additionally, AmeriCorps proactively reached out to several individuals both within AmeriCorps and former and current respondents outside of AmeriCorps and received the following feedback:

• The approximate of 20 minutes to fill out the forms is slightly under the 30 mins it took to complete the form. The instructions are very clear and the format is logical and easy to follow.

• I found the language clear.

• The options following the exemptions for not having acquired a high school diploma I had never seen before, and thought was extremely helpful.

These individuals provided the following suggestions. AmeriCorps’ response is in italics following each suggestion:

• I would add page numbers to the application – Page numbers have been added.

• One of the checked box questions ask if the individual wants to receive information about AmeriCorps Climate Corps which doesn’t exist anymore – This option has been deleted from the draft reviewed because the American Climate Corps has been terminated.

• We use CNCS and AmeriCorps interchangeably but do not explain or say AmeriCorps formally known as CNCS. References to CNCS have been updated to AmeriCorps to avoid confusion.

AmeriCorps has considered this input and has added page numbers and deleted reference to the terminated program as described above.

9. Gifts or Payment.

There are no payments or gifts to respondents as an incentive to provide the requested information.

  

10. Privacy & Confidentiality.

This information collection does collect PII and is covered by the system of records notice AmeriCorps-04-CPO-MMF-Member Management Files. The following privacy statement is included on the instrument:

Privacy Act Statement: AmeriCorps is required by the Privacy Act of 1974 (5 U.S.C. 552a) to tell you what personal information we collect via this website (e.g. name, contact information, demographics, education and employment history, criminal history, medical information) and how it will be used: Authorities – My AmeriCorps requests your personal information pursuant to 42 U.S.C. Chapter 129 - National and Community Service, 42 U.S.C. Chapter 66 - Domestic Volunteer Services, and Executive Order 9397, as amended. Purposes – It is requested to (1) manage your application, service, and post-service benefits and (2) evaluate how to enhance AmeriCorps. Routine Uses – Routine uses of this information may include disclosure to complete your background check, to process your payments, to manage and oversee your service, and other reasons consistent with why it was collected. Effects of Nondisclosure – This request is voluntary, but not providing the information may limit your ability to become a Member, continue being a Member, or receive Member benefits. Additional Information – The applicable system of records notice is AmeriCorps-04-CPO-MMF-Member Management Files (MMF).

11. Sensitive Questions.

The information collection does not include questions of a sensitive nature.

12. Burden Estimate.

AmeriCorps estimates that, on average, it will take each respondent approximately 45 minutes (0.75 hours) complete the form. The estimated respondent burdens and labor costs are shown in the following table.

Estimation of Respondent Burden
	Member Enrollment and Exit Form	Member Application	Total
Number of respondents	296,000	225,000	521,000
Responses per respondent	1	1	1
Number of responses	296,000	225,000	521,000
Hours per response	.75	.75	.75
Total estimated hours (number of responses multiplied by hours per response)	222,000	168,750	390,750*
Cost per hour (hourly wage)	$51.65	$51.65	$51.65
Annual salary public burden (estimated hours multiplied by cost per hour)	$11,446,300	$8,715,938	$20,182,238

* This is the rounded-up estimate of total burden hours based on 0.75 hours per response.

Note: The cost per hour is based on the average of eight 2025 OPM GS hourly rates (base + locality) for a GS-11, step 1 employee living in our eight regions of operation, plus the 36.25% civilian personnel full fringe benefit rate from OMB memorandum M-08-13. The average cost per hour is $37.91 (average hourly rate) + $13.74 ($37.91 average hourly rate x 36.25% fringe) = $51.65/hour (rounded to the nearest penny).

The 2025 GS-11, step 1 hourly rates for the eight regions of operation are as follows: South Central - Austin, TX ($36.42), Southeast - Atlanta, GA ($37.46), Midwest - Columbus, OH ($36.97), Northeast – Albany, NY ($36.55), Mountain - Denver, CO ($39.50), North Central - Kansas City, MO ($36.01), West - Los Angeles, CA ($41.30) and Mid-Atlantic - Philadelphia, PA ($39.04). The average hourly rate is the sum of these hourly rates divided by eight = $37.91/hour (rounded to the nearest penny).

Changes to Burden

	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	521,000	N/A	N/A	N/A	N/A	521,000
Annual IC Time Burden (Hours)	390,750	N/A	N/A	N/A	N/A	390,750
Annual IC Cost Burden (Dollars)	$20,182,238	N/A	N/A	N/A	N/A	12,946,850

The total IC cost burden increased by $7,235,388 to account for increases in the GS rate and because the past estimate failed to reflect the average of all eight regions.

Burden per Response:

	Time Per Response	Hours	Cost Per Response
Reporting	.75	.75	$39.00
Record Keeping	0	0	0
Third Party Disclosure	0	0	0
Total	.75	.75	$39.00

Annual Burden:

	Annual Time Burden (Hours)	Annual Cost Burden (Dollars)
Reporting	390,750	$12,946,850
Record Keeping	0	0
Third Party Disclosure	0	0
Total	390,750	$12,946,850

13. Estimated nonrecurring costs.

This information collection does not impose any annual nonrecurring cost burden on respondents, as the respondents are applicants and grantees who will already have mechanisms in place to track who they serve and who are on staff and in leadership positions at their organization. No capital and start-up costs are expected.

14. Estimated cost to the Government.

The annual cost to AmeriCorps of the AmeriCorps Member Application, Enrollment and Exit Form is $6,142,590 based on our estimate that it takes AmeriCorps staff a total of 130,250 hours to administer and review this information collection. This annual cost is salary expense for the AmeriCorps staff manage/oversee this information collection. We estimate that approximately 1 staff will assist with these efforts. We are using an average GS-12 salary, Step 10 (similar to average of NY-3) at $47.16/hour.

The federal government employee salary information was obtained from OPM’s 2022 Salary Table for the Rest of the U.S. (RUS) at https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2022/RUS_h.pdf and includes a 1.5 multiplier to account for the costs of benefits.

15. Reasons for changes.

The change to the annual cost burden in this information collection is due to adjustment in agency estimate to account for increases in the GS rate and because the past estimate failed to reflect the average of all eight regions. Changes to the forms are necessary to comply with executive order requirements and updated information but do not affect burden estimates.

16. Publicizing Results.

Not applicable because the results will not be published.

17. OMB Not to Display Approval.

AmeriCorps will display the expiration date of OMB’s approval.

18. Exceptions to "Certification for Paperwork Reduction Submissions."

There are no exceptions to the certification statement.

19. Surveys, Censuses, and Other Collections that Employ Statistical Methods.

Not applicable.