Information Collection

Impact Evaluation of Departmentalized Instruction in Elementary Schools

IC 229630 under ICR 201801-1850-001 · OMB 1850-0942.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1850-0942 can be found here:

Documents and Forms

Document Name Document Type
Impact Evaluation of Departmentalized Instruction in Elementary Schools Form
Appendix G District_Recruitment_Letter.pdf Other-District Recruitment Letter
Monitoring Forms and Principal Interview Protocol Appendix A Monitoring_Forms_Principal_Interview.pdf Form
Teacher Survey with Initiave Letter Appendix B Teacher_Letter_Survey_Followup Matls.pdf Form
Admin Records Data Request Appendix C Admin_Records_Data_Requests.pdf Form
Class Schedule and Roster Request Letter Appendix D Letter_Requesting_Class_Schedules_and_Student_Rosters.pdf Form
Active and Passive Parent Permission Form Appendix E Active_and_Passive_Parent_Permission.pdf Form
School Agreement Form Appendix F School_Agreement_Form.pdf Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Impact Evaluation of Departmentalized Instruction in Elementary Schools	Agency IC Tracking Number:	ED-2018-ICCD-0001

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?	Electronic Capability
Form	N/A	Monitoring Forms and Principal Interview Protocol	Appendix A Monitoring_Forms_Principal_Interview.pdf	No	Paper Only
Form	N/A	Teacher Survey with Initiave Letter	Appendix B Teacher_Letter_Survey_Followup Matls.pdf	No	Paper Only
Form	N/A	Admin Records Data Request	Appendix C Admin_Records_Data_Requests.pdf	No	Paper Only
Form	N/A	Class Schedule and Roster Request Letter	Appendix D Letter_Requesting_Class_Schedules_and_Student_Rosters.pdf	No	Paper Only
Form	N/A	Active and Passive Parent Permission Form	Appendix E Active_and_Passive_Parent_Permission.pdf	No	Paper Only
Form	N/A	School Agreement Form	Appendix F School_Agreement_Form.pdf	No	Paper Only
Other-District Recruitment Letter			Appendix G District_Recruitment_Letter.pdf	No	Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 8,531	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 17 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	8,531	8,531
Annual IC Time Burden (Hours)	3,202	3,202
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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