Information Collection

Evaluating the Retired Mentors for New Teachers Program

IC 210283 under ICR 201402-1850-003 · OMB 1850-0908.

Documents and Forms

Document Name Document Type
Form Attachment C Mento Evaluating the Retired Mentors for New Teachers Program Form
Attachment C Mento Attachment C Mentor Focus Group OKCE 4.4.3 Attachment C.docx Form
Attachment E: Mentor Information and Informed Consent OKCE_4.4.3Attachment_E[1].doc Form and Instruction
Attachment D: Teacher Info and Informed Consent CE 4.4.3 OMB Clearance Attachment D 1-14-14.doc Form
Mentee Survey 2013 CE 4.4.3 OMB Clearance Attachment A 1-14-14.pdf Form and Instruction
OKCE_4.4.3_Attachement_H[1].doc OKCE_4 IC Document
CE 4.4.3 OMB Clearance Attachment G 1-14-14.doc Teacher Survey Invite IC Document
CE 4 4 3 Affidavit Attachment J.docx CE 4 4 3 Affidavit Attachment J IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluating the Retired Mentors for New Teachers Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	Attachment C Mentor Focus Group	Attachment C Mentor Focus Group	OKCE 4.4.3 Attachment C.docx	No	No	Paper Only
Form and Instruction	N/A	Attachment E: Mentor Information and Informed Consent	OKCE_4.4.3Attachment_E[1].doc	Yes	Yes	Fillable Fileable
Form	n/a	Attachment D: Teacher Info and Informed Consent	CE 4.4.3 OMB Clearance Attachment D 1-14-14.doc	Yes	Yes	Paper Only
Form and Instruction	n/a	Mentee Survey 2013	CE 4.4.3 OMB Clearance Attachment A 1-14-14.pdf	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 148	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 69 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	148	148
Annual IC Time Burden (Hours)	92	92
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
OKCE_4	OKCE_4.4.3_Attachement_H[1].doc	10/23/2013
Teacher Survey Invite	CE 4.4.3 OMB Clearance Attachment G 1-14-14.doc	01/29/2014
CE 4 4 3 Affidavit Attachment J	CE 4 4 3 Affidavit Attachment J.docx	01/30/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.