Information Collection

Evaluation of A Toolkit to Support Evidence-Based Writing Instruction in Grades 2 Through 4

IC 262767 under ICR 202310-1850-001 · OMB 1850-0993.

Documents and Forms

Document Name Document Type
Evaluation of A Toolkit to Support Evidence-Based Writing Instruction in Grades 2 Through 4 Form
Appendix I_Student Writing Sample Prompts and Rubrics_revised.docx Other-Student Writing Sample Prompts
Appendix I_Student Writing Sample Prompts and Rubrics_revised.docx Other-Student Writing Sample Prompts
Appendix M_District Administrative Records.docx Other-District Administrative Record
Appendix M_District Administrative Records.docx Other-District Administrative Record
Teacher Baseline Survey (Fall) Appendix B_Teacher Baseline Survey (Fall).docx Form
Teacher Baseline Survey (Fall) Appendix B_Teacher Baseline Survey (Fall).docx Form
Teacher Log (Fall and Spring) Appendix D_Teacher Log.docx Form
Teacher Log (Fall and Spring) Appendix D_Teacher Log.docx Form
PLC Post-Session Form Appendix F_PLC Facilitator Form_Post-Session.docx Form
PLC Post-Session Form Appendix F_PLC Facilitator Form_Post-Session.docx Form
PLC Final Implementation Form Appendix G_PLC Facilitator Form_Final Implementation.docx Form
PLC Final Implementation Form Appendix G_PLC Facilitator Form_Final Implementation.docx Form
Teacher Follow-Up Survey (Spring) Appendix C_Teacher Follow-Up Survey (Spring).docx Form
Teacher Follow-Up Survey (Spring) Appendix C_Teacher Follow-Up Survey (Spring).docx Form
Teacher Implementation Survey Appendix E_Teacher Implementation Survey.docx Form
Teacher Implementation Survey Appendix E_Teacher Implementation Survey.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Evaluation of A Toolkit to Support Evidence-Based Writing Instruction in Grades 2 Through 4	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	N/A	Teacher Baseline Survey (Fall)	Appendix B_Teacher Baseline Survey (Fall).docx	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Log (Fall and Spring)	Appendix D_Teacher Log.docx	Yes	Yes	Fillable Fileable
Form	N/A	PLC Post-Session Form	Appendix F_PLC Facilitator Form_Post-Session.docx	Yes	Yes	Fillable Fileable
Form	N/A	PLC Final Implementation Form	Appendix G_PLC Facilitator Form_Final Implementation.docx	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Follow-Up Survey (Spring)	Appendix C_Teacher Follow-Up Survey (Spring).docx	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Implementation Survey	Appendix E_Teacher Implementation Survey.docx	Yes	Yes	Fillable Fileable
Other-Student Writing Sample Prompts and Rubrics			Appendix I_Student Writing Sample Prompts and Rubrics_revised.docx	Yes	Yes	Fillable Fileable
Other-District Administrative Records			Appendix M_District Administrative Records.docx	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: 1,047	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,188	4,188
Annual IC Time Burden (Hours)	1,237	1,237
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.