Disability Employment Initiative Grantee Site Visits - State Employees

Disability Employment Initiative Evaluation

Documents and Forms

Document Name Document Type
DEI Eval Site Visit Question Matrix.xls Other-Interview Guide
101812_ME DEI Supplemental Questionnaire REVISED 1-25-13 20130123).docx DEI Supplemental Questionnaire for Maine IC Document
101812_WI DEI Supplemental Questionnaire-Berge REVISED 1-25-13 20130123.docx DEI Supplemental Questionnaire for Wisconsin IC Document
DEI_Training_Site_Visit__Interview_Logistics__Protocol_01-26-13_JV_Final.doc Site Visit Protocol IC Document

Information Collection (IC) Details

IC Title:	Disability Employment Initiative Grantee Site Visits - State Employees	Agency IC Tracking Number:

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-Interview Guide			DEI Eval Site Visit Question Matrix.xls		No		Paper Only

Line of Business: Workforce Management

Subfunction: Labor Rights Management

Privacy Act System of Records
Title: System of Records Notice, DOL/ETA-15	FR Citation: 67 FR 16898

Number of Respondents: 16	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	368	368
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
DEI Supplemental Questionnaire for Maine	101812_ME DEI Supplemental Questionnaire REVISED 1-25-13 20130123).docx	01/30/2013
DEI Supplemental Questionnaire for Wisconsin	101812_WI DEI Supplemental Questionnaire-Berge REVISED 1-25-13 20130123.docx	01/30/2013
Site Visit Protocol	DEI_Training_Site_Visit__Interview_Logistics__Protocol_01-26-13_JV_Final.doc	01/30/2013

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