Principle, Prevention Coordinator and Teacher Baseline Survey

Evaluation of the Safe Dates Project

Documents and Forms

Document Name Document Type
Attachment V - Baseline Teacher Survey.docx Other-WORD
Attachment O - Baseline principal survey.docx Other-WORD
Attachment R - Baseline Prevention Coordinator Survey.docx Other-WORD
Attachment E - Lead Letter to Parents.docx Attachment E - Lead Letter to Parents IC Document

Information Collection (IC) Details

IC Title:	Principle, Prevention Coordinator and Teacher Baseline Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD	Attachment V - Baseline Teacher Survey.docx	Yes	Yes	Fillable Printable
Other-WORD	Attachment O - Baseline principal survey.docx	Yes	No	Fillable Printable
Other-WORD	Attachment R - Baseline Prevention Coordinator Survey.docx	Yes	Yes	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	Previously Approved
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
Attachment E - Lead Letter to Parents	Attachment E - Lead Letter to Parents.docx	09/23/2010

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