Are you responsible for filing form 301A? If so, understanding the importance of this federal form and submitting it on time is key to staying compliant with the U.S. Department of Labor's regulations. This blog post will provide a comprehensive overview of Optional Form 301A and how to properly complete and file it according to US labor law - giving you peace of mind when it comes to fulfilling your obligations with regard to these important forms!
Question | Answer |
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Form Name | Optional Form 301A |
Form Length | 2 pages |
Fillable? | No |
Fillable fields | 0 |
Avg. time to fill out | 30 sec |
Other names | usda form 301a, 2010, usfs volunteer agreement form, Washington |
OMB
Volunteer Services Agreement for Natural Resources Agencies
for Individuals or Groups- Please complete Green boxes
Please print when completing this form |
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Name of Volunteer or Group Leader – Last, First, Middle |
Reimbursement |
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(if any) |
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U.S. Forest Service at Midewin/ See Attachments |
Not Applicable |
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Group Name (if applicable) |
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Age |
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Under 18 |
56 and Older |
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Are you a U.S. Citizen? |
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Preferred PhonE |
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Email Address |
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Yes |
No (Visa Type) |
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Home |
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Work |
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Street Address |
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IF VOLUNTEER IS UNDER AGE 18– Name of Parent/ Legal Guardian
Home Phone
Mobile Phone
Email Address
Street Address (If different than above)
City
State
Zip
I affirm that I am the parent/guardian of the above named volunteer. I understand that the agency volunteer program does not provide compensation, except as otherwise provided by law; and that the service will not confer on the volunteer the status of a Federal employee. I have read the attached description of the service that the volunteer will perform.
I give my permission |
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for |
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to participate in the specified volunteer activity sponsored |
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by |
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at |
Midewin National Tallgrass Prairie |
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(Name of Group, if applicable) |
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(Name of Volunteer Duty Station) |
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From |
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to |
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(Date) |
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(Date) |
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(Parent/Guardian Signature) |
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(Date) |
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Emergency Contact Name |
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Email Address |
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PhonE |
Cell |
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Home |
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Work |
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Street Address (if different than above) |
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City |
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State |
Zip |
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GOVERNMENT OFFICIAL COMPLETES THIS SECTION
If you are a group leader, please attach a roster or list participants’ names in this box.
Government Vehicle required? |
Yes |
No |
Valid State Driver’s License |
International Driver’s License |
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Personal Vehicle to be used? |
Yes |
No |
Please verify that the volunteer is in possession of one of these documents. |
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DO NOT keep a copy of the document for his/her file. |
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Optional Form 301a (09/2010) |
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OMB
I understand that I will not receive any compensation for the above service and that volunteers are NOT considered Federal employees for any purpose other than tort claims and injury compensation. I understand that volunteer service is not creditable for leave accrual or any other employee benefits. I also understand that either the government or I may cancel this agreement at any time by notifying the other party.
I understand that my volunteer position may require a reference check, background investigation, and/or a criminal history inquiry in order for me to perform my duties.
I understand that all publications, films, slides, videos, artistic or similar endeavors, resulting from my volunteer services as specifically stated in the attached job description, will become the property of the United States, and as such, will be in the public domain and not subject to copyright laws.
I understand the health and physical condition requirements for doing the work as described in the job description and at the project location, and certify that the statement I have checked below is true:
No medical condition or physical limitation that may adversely affect my ability to provide this service.
I do know of a medical condition or physical limitation that may adversely affect my ability to provide this service and have explained it to
___________________________________________________.
(Name of Agency Official)
I do hereby volunteer my services as described above, to assist in
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(Signature of Volunteer) |
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(Date) |
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The
(Signature of Government Representative) |
(Date) |
Termination of Agreement
Volunteer requests formal evaluation |
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Yes |
Agreement terminated on
(Date)
No |
Evaluation Completed |
(Date)
(Signature of Government Representative)
Public Burden Statement
According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is
The U.S. Department of Agriculture (USDA) and U.S. Department of the Interior (USDI) 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
To file a complaint of discrimination, write USDA, Director, Office of Civil Rights, 1400 Independence Avenue, SW, Washington, DC
Privacy Act Statement
Collection and use is covered by Privacy Act System of Records
2 |
Optional Form 301a (09/2010) |
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