Information Collection

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

IC 183239 under ICR 200801-0920-002 · OMB 0920-0783.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.