Information Collection

Random Assignment Evaluation of Pacific CHILD

IC 181897 under ICR 200808-1850-009 · OMB 1850-0847.

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
83C-Change Sheet1850-0847 REL PA 9 10 08.doc OMB 83C for !850-0847 Teacher Survey	IC Document

IC Title:

Agency IC Tracking Number:

3368

Is this a Common Form? No

IC Status: Modified

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: 188

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	Previously Approved
Annual Number of Responses for this IC	188	-17	205
Annual IC Time Burden (Hours)	225	14	211
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
OMB 83C for !850-0847 Teacher Survey	83C-Change Sheet1850-0847 REL PA 9 10 08.doc	09/11/2008

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