Information Collection

CPTED Administration by Teachers

IC 197772 under ICR 201105-0920-010 · OMB 0920-0898.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 CPTED Student Survey CPTED Administration by Teachers	Form and Instruction
Form 1 CPTED School Site Data Form CPTED Administration by Teachers	Form and Instruction
Form 3 CRIME PREVENTION THROUGH ENVIRONMENTAL DESIGN (CPTED) STUDENT SURVEY CPTED Administration by Teachers	Form
2 CPTED Student Survey APPENDIX G_CPTED Student Survey.doc	Form and Instruction
1 CPTED School Site Data Form APPENDIX F_CPTED School Site Data Form.doc	Form and Instruction
3 CRIME PREVENTION THROUGH ENVIRONMENTAL DESIGN (CPTED) ST APPENDIX N 3459~1.DOC	Form
APPENDIX E.docx APPENDIX E	IC Document
APPENDIX K_School Administrator Consent Form_OMB.doc APPENDIX K_School Administrator Consent Form_OMB	IC Document
APPENDIX H 1362~1.DOC APPENDIX H 1362~1	IC Document
APPENDIX I_CPTED Parental Permission Form and Survey Fact Sheet.doc APPENDIX I_CPTED Parental Permission Form and Survey Fact Sheet	IC Document
APPENDIX J_Parental Permission Form Reminder Notice_OMB.doc APPENDIX J_Parental Permission Form Reminder Notice_OMB	IC Document
APPENDIX P_CPTED Student Survey Make-Up List_OMB_110410.doc APPENDIX P_CPTED Student Survey Make-Up List_OMB_110410	IC Document
APPENDIX Q_CPTED Student Survey Administration Guide_OMB.doc APPENDIX Q_CPTED Student Survey Administration Guide_OMB	IC Document
APPENDIX R_Summary of School Arrangements Form_OMB.doc APPENDIX R_Summary of School Arrangements Form_OMB	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	2	No	No	Paper Only
Form and Instruction	1	Yes	Yes	Fillable Fileable
Form	3	No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
APPENDIX E		05/16/2011
APPENDIX K_School Administrator Consent Form_OMB		05/16/2011
APPENDIX H 1362~1		05/16/2011
APPENDIX I_CPTED Parental Permission Form and Survey Fact Sheet		05/16/2011
APPENDIX J_Parental Permission Form Reminder Notice_OMB		05/16/2011
APPENDIX P_CPTED Student Survey Make-Up List_OMB_110410		05/16/2011
APPENDIX Q_CPTED Student Survey Administration Guide_OMB		05/16/2011
APPENDIX R_Summary of School Arrangements Form_OMB		05/16/2011

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

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