Information Collection

State Interviews

IC 195888 under ICR 201012-1875-001 · OMB 1875-0260.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State Interview Protocol7 28 11 (2).docx	Other-protocol
Equitable Distribution Informed Consent State 7 28 11 (2).docx State Informed Consent form	IC Document

IC Title:

State Interviews

Agency IC Tracking Number:

4426

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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
Other-protocol			State Interview Protocol7 28 11 (2).docx		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 17

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	17	17
Annual IC Time Burden (Hours)	43	43
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
State Informed Consent form	Equitable Distribution Informed Consent State 7 28 11 (2).docx	07/29/2011

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