Information Collection

State Interviews

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

Documents and Forms

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

Information Collection (IC) Details

View Information Collection (IC)

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:

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 %

	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

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.