Evaluation of the Safe Dates Project - Student Effectiveness Baseline 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⚠️ Notice: This information collection may be referencing outdated material.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
Student Effectiveness BaselineSurvey.doc Instruction
SafeDates_OMB_Appendix-H.doc Letter to Parents to Recruit Students for Effectiveness Evaluation IC Document
SafeDates_OMB_Appendix-I.doc Parent/Guardian Informed Consent/Teen Assent & Script IC Document

Information Collection (IC) Details

IC Title:	Evaluation of the Safe Dates Project - Student Effectiveness Baseline 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			Student Effectiveness BaselineSurvey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 10,158	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	10,158	10,158
Annual IC Time Burden (Hours)	5,926	5,926
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Letter to Parents to Recruit Students for Effectiveness Evaluation	SafeDates_OMB_Appendix-H.doc	12/18/2007
Parent/Guardian Informed Consent/Teen Assent & Script	SafeDates_OMB_Appendix-I.doc	12/18/2007

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