Corporation for National and Community Service (AmeriCorps)
Childcare Benefit Forms
OMB Control Number 3045-0142
Justification – Part A Supporting Statement
Overview of Information Collection: This is a request for extension of an existing information collection, which allows members serving in AmeriCorps programs to obtain childcare benefits and includes eight forms. These forms are submitted by AmeriCorps members and by childcare providers for the purpose of applying for, and receiving payment for, the care of children during the day while the AmeriCorps members are serving. Non-substantive changes are being made to the Provider Application form and Member Application form to replace “gender” with “sex.”
Need & Method for the Information Collection.
Section 140(e) of the National and Community Service Act of 1990, as amended, requires the making childcare available for children of AmeriCorps members who need such childcare in order to participate in the national service program or provide a childcare allowance to each AmeriCorps member who needs such childcare in order to participate in the national service program. See 42 U.S.C. 12594(e). Regulations implementing this provision are at 45 CFR 2252.250(a).
The information is collected electronically through the following forms, managed by an AmeriCorps contractor:
Provider Application –the application completed by the childcare provider and certified by the AmeriCorps member.
Member Application –how AmeriCorps members apply to receive the childcare benefit.
Childcare attendance sheet invoice –the form the childcare provider submits to document each child’s attendance hours and weekly charges.
Statement of Work Activity –the AmeriCorps member completes this form if they or their spouse work as an independent contractor or are self-employed.
Member Update form – the AmeriCorps member completes this form if there ais any change to the childcare application they submitted (e.g., change of address, family size, work site)
Childcare Payment Authorization – the childcare provider completes this form to provide financial institution and account information for payment.
AmeriCorps Unlicensed Provider Affidavit – the AmeriCorps member completes this form if they choose an unlicensed childcare provider, to attest that they assume responsibility for conducting a criminal background check on the provider.
Program Certification of Active Service – the AmeriCorps member completes this form and the AmeriCorps Program Director signs this form to certify that the individual is currently an active AmeriCorps member in need of childcare services in order to serve in the program.
If this collection is not conducted or is conducted less frequently, the statutory requirement to provide childcare benefits to eligible AmeriCorps members will be unfulfilled.
Use of the Information.
AmeriCorps members receive these forms via a link through their AmeriCorps program director, upon request. Learning costs should be minimal, as the AmeriCorps member will have the information requested readily available, as the forms request information about their own circumstances and nothing on the forms should impose any psychological costs. Likewise, the childcare providers who fill in these forms should encounter no learning or psychological costs, as the information requested is part of information that must be provided to obtain payment for their services. AmeriCorps, through its contractor, uses the information collected to determine member and provider eligibility for the childcare benefit and to determine the amount to be paid throughout the member’s term of service. This information is not used by other Federal agencies.
Use of Information Technology.
AmeriCorps provides and accepts these forms electronically via the contractor’s secure website. If applicants are unable to submit the information online, they can use hard copy forms and instructions to submit their information by mail or fax.
Non-duplication.
There are no other sources of information by which AmeriCorps can determine who among AmeriCorps members is requesting and eligible for childcare benefits and whether the childcare providers are eligible or and the amount to be paid for providing childcare services.
Burden on Small Business.
This collection of information may impact small businesses if a small business is applying to be a childcare provider for an AmeriCorps member. There is no economic burden to any small businesses 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 absolutely necessary to assess the business’s eligibility to be a childcare provider and to determine the rate the provider should be paid.
Less Frequent Collection.
AmeriCorps would be unable to determine member or provider eligibility to receive the childcare benefit or the appropriate amount to be paid.
Paperwork Reduction Act Guidelines.
One of the forms, the AmeriCorps Childcare Attendance Sheet Invoice, must be submitted more than quarterly; this form is required to be submitted monthly in order to receive monthly benefit payments. For all other forms, there are no special circumstances that would require the collection of information in these ways.
Consultation and Public Comments.
The notice providing the public with 60 days to comment on this information collection was published on December 17, 2024 at 89 Fed. Reg. 102118. No comments were received in response to this notice.
Additionally, AmeriCorps proactively reached out to consult with representatives of AmeriCorps members and providers for their input on the information collection. AmeriCorps has reached out to eight individuals for input, including AmeriCorps members and their supervisors and the childcare providers that they selected, requesting input but nobody responded with any suggestions for changes or edits to improve the forms.
Gifts or Payment.
Childcare providers who respond to this information collection and are then approved receive childcare benefit payments, but no gift or payment is provided as an incentive to respond to this information collection.
Privacy & Confidentiality.
This information collection includes AmeriCorps members’ personally identifiable information and is covered by the Privacy Act System of Record Notice , CNCS–06–CPO–ACB–AmeriCorps Child Care Benefit System (ACB).
Authorities – This information is requested pursuant to the National and Community Service Act of 1990 as amended (42 USC 12501 et seq.), the Domestic Volunteer Service Act of 1973 as amended (42 USC 4950 et seq.), and E.O. 9397 as amended. Purposes – It is requested to manage, administer, and evaluate the childcare benefits program offered to eligible AmeriCorps Service Members. Routine Uses – Routine uses of this information may include disclosure to (1) contractors to assist with administering the childcare benefit, (2) individuals and organizations providing childcare, and (3) federal, state, or local agencies pursuant to lawfully authorized requests. A complete list of uses can be found in the system of records notice associated with this collection of information, CNCS–06–CPO–ACB–AmeriCorps Child Care Benefit System (ACB). Effects of Nondisclosure – This request is voluntary, but not providing the information will likely affect your ability to receive childcare benefits.
Sensitive Questions.
Family income information is collected from AmeriCorps members for purposes of determining their eligibility to receive the childcare benefit. Applicants are informed that “this request is voluntary, but not providing the information will likely affect your ability to received childcare benefits.” Bank account information is collected from childcare providers who choose to receive electronic payments to allow the payments to be transferred.
Burden Estimate.
AmeriCorps estimates no more than 450 AmeriCorps members and 590 childcare providers to respond to this information collection, totally 1,040 respondents. With the exception of the monthly AmeriCorps Childcare Attendance Sheet Invoice, which has no estimated annual hour burden outside of the customary and usual business practices, the frequency of response will not be greater than annually and estimated hour burden of each response is 30 minutes of effort per respondent.
Though there has been no change to the estimated 30 minutes per response, there has been a change in burden hours due to an adjustment in agency estimate because AmeriCorps decreased its estimate of respondents from 2,100 to 1,040 based on a decrease in childcare benefit requests over the past few years. The number of respondents has been adjusted to the average number of members and childcare providers that requested and provided childcare as part of this program in the past few years, plus an additional 100 for each to account for possible fluctuations.
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Burden per Response:
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The cost per response is an average of the cost per hour for AmeriCorps members, which is approximately $8 per hour based on the average hourly living allowance earned by AmeriCorps members, and the average cost per hour for childcare providers, which is approximately $14.40 based on the average hourly rate made by childcare providers.
Annual Burden:
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Estimated nonrecurring costs.
There are no capital and start-up costs or operation and maintenance costs associated with this information collection.
Estimated cost to the Government.
The cost to the government is approximately $187,000 per year for a contractor to manage collection and review of the forms and distribution of funding as appropriate.
Reasons for changes.
There has been a change in burden hours due to an adjustment in agency estimate because AmeriCorps decreased its estimate of respondents from 2,100 to 1,040 based on a decrease in childcare benefit requests over the past few years.
Publicizing Results.
Not applicable: no results will be published.
OMB Not to Display Approval.
Not applicable: the expiration date for OMB approval of the information collection will be displayed.
Exceptions to "Certification for Paperwork Reduction Submissions."
There are no exceptions to the certification statement.
Surveys, Censuses, and Other Collections that Employ Statistical Methods.
This information collection does not include surveys or censuses.
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