Evaluation of the Safe Dates Project - Principle, Prevention Coordinator and Teacher Baseline Implementation Survey

Evaluation of the Safe Dates Project

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0783 can be found here:

Documents and Forms

Document Name Document Type
Apx B Baseline Implementation Pprincipal and Prevention Coordinator Survey.doc Instruction
Baseline Teacher Survey.doc Instruction
SafeDates_OMB_Appendix-J.doc Lead Letter to School Staff IC Document

Information Collection (IC) Details

IC Title:	Evaluation of the Safe Dates Project - Principle, Prevention Coordinator and Teacher Baseline Implementation Survey	Agency IC Tracking Number:

Is this a Common Form? Yes		IC Status: New

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
Instruction			Apx B Baseline Implementation Pprincipal and Prevention Coordinator Survey.doc		No	No	Fillable Printable
Instruction			Baseline Teacher Survey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 196	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	196	196
Annual IC Time Burden (Hours)	49	49
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Lead Letter to School Staff	SafeDates_OMB_Appendix-J.doc	12/18/2007

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