Information Collection

Screener and Interview Protocol

IC 234499 under ICR 202003-1850-006 · OMB 1850-0947.

Documents and Forms

Document Name Document Type
Appendix A interview protocol final.docx Other-Protocol
Appendix B Mathematica Confidentiality Pledge.pdf Confidentiality Pledge IC Document
Appendix C Advance email 5.9.19.docx Email Confirmaiton IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Screener and Interview Protocol	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Protocol			Appendix A interview protocol final.docx		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 110	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	110	50	60
Annual IC Time Burden (Hours)	52	25	27
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Confidentiality Pledge	Appendix B Mathematica Confidentiality Pledge.pdf	05/14/2019
Email Confirmaiton	Appendix C Advance email 5.9.19.docx	05/14/2019

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