OMB 0596-0080 (Expires 12/2013)
15. a. Which months would you be available for volunteer work?
December
15b. How many hours per week would you be available for volunteer work? Hours
15c. Which days per week would you be available for volunteer work?
Monday Tuesday Wednesday Thursday Friday Saturday Sunday
16. Specify at least three states or specific locations within a state where you would like to do volunteer work.
17. Specify your lodging needs:
I will furnish my own lodging (such as tent; camper; own, relative’s, or friend’s place)
I will require assistance in finding lodging
18. If a volunteer assignment is not available at the location specified in item 16, do you want your application forwarded to
another location or Federal agency seeking volunteers with your background/interests?
Yes No (Please specify)
19. This is provided for more detailed responses. Please indicate the item numbers to which these responses apply:
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respo
nd to a collection of information unless it
displays a valid OMB control number. The valid OMB control number for this information collection is 0596-
0080. The time required to complete this information collection
is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed,
and completing and reviewing the collection of information.
The U.S. Department of Agriculture (USDA) and U.S. Department of the Interior
prohibit discrimination in all programs and activities on the basis of race, color, national
origin, gender, religion, age, disability, political beliefs, sexual orientation, and marital or family status. (Not all prohibited bases apply to all programs.) Persons with
disabilities who require alternative means for communication of program information (Braille, large print, audiotape, etc.) should contact USDA’s TARGET Center at 202-
720-2600 (voice and TDD).
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC 20250-9410 or call (800) 795-3272
(voice) or (202) 720-6382 (TDD). USDA and USDI are equal opportunity providers and employers.
Volunteers are not considered Federal employees for any purposes other than tort claims and injury compensation. Volunteer service is not creditable
for leave accrual or any other benefit. However, volunteer service is creditable work experience. By signing this application the volunteer(s)
understand(s) s/he may be subject to a reference check, background check, and/or criminal history inquiry.
Collection and use is covered by Privacy Act System of Records OPM/GOVT-1 and USDA/OP-1, and is consistent with the provisions of 5 USC 552a
(Privacy Act of 1974), which authorizes acceptance of the information requested on this form. The data will be used to maintain official records of
volunteers of the USDA and USDI for the purposes of tort claims and injury compensation. Furnishing this data is voluntary, however if this form is
incomplete, enrollment in the program cannot proceed.
20. Signature (Sign in ink)
20. Date
2 Optional Form 301 (Revised 06/2008)
USDA-USDI
