Principle and Prevention Coordinator Mid-Implementation Survey

Evaluation of the Safe Dates Project

Documents and Forms

Document Name Document Type
Attachment P - Mid implementation principal survey.docx Other-WORD
Attachment S - Midimpl PC Survey.docx Other-WORD

Information Collection (IC) Details

IC Title:	Principle and Prevention Coordinator Mid-Implementation 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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Attachment S - Midimpl PC Survey.docx		Yes	Yes	Fillable Printable
Other-WORD			Attachment P - Mid implementation principal survey.docx		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 %

	Approved	Previously Approved
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

Title	Document	Date Uploaded
No associated records found

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