OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Student Effectiveness Baseline Survey

IC 183244 under ICR 201010-0920-005 · OMB 0920-0783.

Documents and Forms
Document Name
Document Type
Other-WORD
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Student Effectiveness Baseline Survey
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Other-WORD Attachment L - Youth Dating Survey.docx Yes Yes Fillable Printable

Health Illness Prevention

 

10,158 0
   
Individuals or Households
 
   0 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 10,158 0 0 0 0 10,158
Annual IC Time Burden (Hours) 5,926 0 0 0 0 5,926
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Attachment I - Safe Dates Student Assent Attachment I - Safe Dates Student Assent.docx 09/23/2010
Attachment H - Parent Brochure Attachment H - Parent Brochure.docx 09/23/2010
Attachment D - Student Privacy Pledge Attachment D - Student Privacy Pledge.doc 09/23/2010
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.