Information Collection

Random Assignment Evaluation of Pacific CHILD

IC 181897 under ICR 200709-1850-001 · OMB 1850-0847.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1850-0847 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Random Assignment Evaluation of Pacific CHILD	Form and Instruction
Teacher Survey Att_Appendix ATeacher Survey.pdf	Form and Instruction
Impact Survey Att_Appendix B_Impact Survey(3368).pdf	Form
Teacher Focus Att_Appendix D_Teacher Focus Group Guide(3368).pdf	Form
Teacher Interview Att_Appendix E_Teacher Interview Guide(3368).pdf	Form
PREL Staff Focus Group Att_Appendix F_PREL Staff Focus Group Guide(3368).pdf	Form
Professional Development Att_Appendix G_Professional Development Protocol(3368).pdf	Form
Clasroom Observation Att_Appendix H_SIOP Classroom observation Instrument(3368).pdf	Form
Consent Forms and Information Sheet Att_Appendix I_ConsentForms and Information Sheet(3368).pdf	Form
Letters of Interest Att_Appendix K_Letters of Interest(3368).pdf	Form
SAmple MOU Att_Appendix L_Sample MOU(3368).pdf	Form

IC Title:

Random Assignment Evaluation of Pacific CHILD

Agency IC Tracking Number:

3368

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Teacher Survey	Att_Appendix ATeacher Survey.pdf	Yes	Yes	Fillable Fileable
Form	N/A	Impact Survey	Att_Appendix B_Impact Survey(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Focus	Att_Appendix D_Teacher Focus Group Guide(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Interview	Att_Appendix E_Teacher Interview Guide(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	PREL Staff Focus Group	Att_Appendix F_PREL Staff Focus Group Guide(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	Professional Development	Att_Appendix G_Professional Development Protocol(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	Clasroom Observation	Att_Appendix H_SIOP Classroom observation Instrument(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	Consent Forms and Information Sheet	Att_Appendix I_ConsentForms and Information Sheet(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	Letters of Interest	Att_Appendix K_Letters of Interest(3368).pdf	Yes	Yes	Fillable Fileable
Form	N/A	SAmple MOU	Att_Appendix L_Sample MOU(3368).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: 205

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 74 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	205	205
Annual IC Time Burden (Hours)	211	211
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.