Legal Status Update Form for the Virtual Service Pilot Program

OMB Control #: Pending
Expiration date: Pending

Please provide an update on your legal status since your Close of Service (COS). If you reply “Yes” to any of the following questions please provide any pertinent details. You may also be contacted with a request for further information.

Privacy Act Statement: The Peace Corps, an agency of the federal government, is required by the Privacy Act of 1974 (5 U.S.C. 552a) to advise you of the following information regarding this application. The Privacy Act addresses the federal government’s use of certain personal information in agency files.

Authority: This application form is authorized by the Peace Corps Act (22 U.S.C. 2501 et seq.) as amended.

Purpose: The information you provide will be used is to consider you for the Peace Corps Virtual Service Pilot Program.

Routine Uses: The information you provide may be used for the routine uses described in the Privacy Act, 5 U.S.C. 552a, and the Peace Corps' published Routine Uses A through N, as defined in the Peace Corps' System of Records PC-10, PC-17, and PC-18. Routine Uses A through N are listed on the Peace Corps Privacy webpage.

Disclosure: The completion of this application is voluntary. However, failure to do so will result in the Peace Corps’ inability to consider you for the Virtual Service Pilot Program.

Paperwork Reduction Notice: Public reporting burden for this information collection is estimated to average 10 minutes. This includes the time for reviewing instructions and completing the information. This is voluntary information collection. An agency may not conduct or sponsor, and persons are not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: Peace Corps FOIA Officer, 1275 First St NE, Washington, DC 20526.

PC-2196 (SEP 2020)