WWC Intervention Form, Long Form

What Works Clearinghouse Database Forms and Customer Survey

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1850-0788 can be found here:

Documents and Forms

Document Name Document Type
Form01_InterventionNominationLong_rev.doc www.whatworks.ed.gov/openinvitation/ Other-Nomination form

Information Collection (IC) Details

IC Title:	WWC Intervention Form, Long Form	Agency IC Tracking Number:	3273

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-Nomination form			Form01_InterventionNominationLong_rev.doc	http://www.whatworks.ed.gov/openinvitation/	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: 133	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 99 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	133	-5,367	5,500
Annual IC Time Burden (Hours)	67	-911	978
Annual IC Cost Burden (Dollars)	0	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.