OCS Grant Reviewer Recruitment Form (Previously approved, ongoing collection)

OMB Control No: 0970-0477

Expiration Date: XX/XX/XXXX

CED Reviewer Registration Form

The Community Economic Development (CED) program asks potential application reviewers to provide the information listed below via a web-based tool. OCS Reviewer Registry - https://ocsrr.acf.hhs.gov

You have to register or login with email and password.

The sub-bullets listed below correspond to choices in drop-down lists or checkboxes included on the web form.

PROFILE

Personal Information

Title

• Brother

• Dr.

• Hon.

• Min.

• Mr.

• Mrs.

• Ms.

• Miss

• Pastor

• Rev.

• Rev. Dr

First Name *

Last Name *

Phone*

Alternate Phone:

Organization/Employer:

Primary Address

Address Line 1*

Address Line 2

City *

State *

• AL

• AK

• AZ

• AR

• CA

• CO

• CT

• DE

• DC

• FL

• GA

• ID

• IL

• IN

• IA

• KS

• KY

• LA

• ME

• MD

• MA

• MI

• MN

• MS

• MO

• MT

• NE

• NV

• NH

• NJ

• NM

• NY

• NC

• ND

• OH

• OK

• OR

• PA

• RI

• SC

• SD

• TN

• TX

• UT

• VT

• VA

• WA

• WV

• WI

• WY

• AS

• FM

• GU

• HI

• MH

• MP

• PR

• VI

• AA

• AE

• AP

• UK

Zip Code*

Mailing Address

• Same as Primary Address

Address Line 1 *

Address Line 2

City *

State * (same options as above)

Zip Code*

VOLUNTARY –

What is your race? (Select one or more)

• Native American / Alaskan Native

• Asian or Pacific Islander

• Black, not of Hispanic origin

• Hispanic

• White, not of Hispanic origin

Expertise Codes

Please select a minimum of three (3) areas that best define your expertise:

• Expertise Choice 1

• Adolescent Health

• Affordable Housing

• Business Development / Expansion

• Capacity-Building

• Child Care / Head Start

• Child Welfare

• Community Development

• Crisis Intervention

• Cultural Diversity

• Cyber Security

• Domestic / Family Violence

• Education

• Employment Services

• Fair Housing

• Financial Services

• Health / Wellness Services

• Homelessness

• Human Resources

• Human Trafficking

• Information Management / Data Analysis

• Legal Services

• Low Income Individuals / Families

• Mental Health Services

• Mortgage/Lending

• Native American / Tribal Services

• Nonprofit / Community Organization Management

• Nutrition

• Process Improvement / Quality Control

• Reentry / Recidivism

• Refugee/Ashlee Services

• Revenue Dev’t Strategies / Fundraising

• Small Business / Entrepreneurship

• Systems Development / Testing / Implementation

• Training & Technical Assistance

• Experience

• Less than 3 years of experience

• 3-7 years of experience

• 7+ years of experience

• Occupation (Most Recent)

• Accountant

• Administrator

• Advisor

• Analyst

• Assistant / Aide / Clerk

• Attorney

• Auditor

• Coordinator

• Counselor

• Developer

• Director

• Doctor (Medical)

• Education / Teacher / Professor

• Engineer

• Evaluator

• Examiner

• Executive

• Financial Officer

• Funder / Investor

• Judge

• Manager

• Officer

• Planner

• Practitioner

• Psychologist

• Researcher

• Scientist

• Social Worker

• Specialist

• Student

• Technician

• Therapist

• Trainer

• Experience Details (comment box – 500 character max)

• Expertise Choice 2:

  • Same list as above

• Expertise Choice 3:

  • Same list as above

• Expertise Choice 4:

  • Same list as above

• Expertise Choice 5:

  • Same list as above

Experience

Have you worked for a non-profit Community Development Corporation (CDC) implementing a Community Economic Development (CED) project from the Office of Community Services? *

• Yes

• No

If yes, what is/was the name of the CDC? (text box)

What was your CED-related job/role?

• Team Lead

• Manager

• Senior Manager

• Partner

• Owner

• Intern

• Consultant

• If other, please describe ___________________

Is your CED/CDC job reflected on the resume you provided to work as a CED grant reviewer?

• Yes

• No

Are you currently or have you ever been a beneficiary of a CED grant (i.e., employed in a job/business created or expanded with a CED grant)?

• Yes

• No

Are you currently a college or graduate student?*

• Yes

• No

What is your highest degree?*

• High School Diploma

• Undergraduate Degree

• Graduate Degree

• Post Graduate Degree

Discipline (text field)

Are you affiliated with a current Federal grant recipient? [Employed by, Consulting for, or Related to a Key Employee] (If Yes, please answer the following question.)*

• Yes

• No

Are you a current Federal Employee? *

• Yes

• No

Are you a current Federal Contractor? *

• Yes

• No

Do you have previous experience as a grant reviewer? *

• Yes

• No

Do you have previous experience as a panel lead?(Chairperson, Team Lead, Facilitator)*

• Yes

• No

When did you last participate in a grant review?* -

• Never

• Within the last 1-3 years

• Within the last 4-6 years

• Within the last 7-10 years

• More than 10 years ago

Are you fluent (speaking/ reading/ writing) in any languages other than English?*

• Yes

• No

How did you hear about the grant review opportunity? *

• Reviewer Referral

• Flyer

• College/University Career Service

• Friend

• Job Fair

• Other

Bio and Resume

Bio (comment box – 700 characters max)

Upload Resume

Sessions

• Add Session Code.

THE PAPERWORK REDUCTION ACT OF 1995 (Pub. L. 104-13)

Public reporting burden for this collection of information is estimated to average 10 minutes per response, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information.

An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.

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