Information Collection

Evaluation of the Safe Dates Project - Principle and Prevention Coordinator Mid-Implementation Survey

IC 183240 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⚠️ Notice: This information collection may be referencing outdated material.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 B1 Mid-implementation Survey Principle.doc	Instruction
Apx B1 Mid-Implementation Survey Program Coordinator.doc Prevention Coordinator Mid-Implementation Survey	IC Document

IC Title:

Evaluation of the Safe Dates Project - Principle and Prevention Coordinator Mid-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 B1 Mid-implementation Survey Principle.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 64

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	64	64
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Prevention Coordinator Mid-Implementation Survey	Apx B1 Mid-Implementation Survey Program Coordinator.doc	12/05/2007

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