Information Collection

Parent Program Fidelity 7th Grade Sessions 1,3,5

IC 199974 under ICR 201110-0920-012 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 11 Parent Program Fidelity 7th Grade Sessions 1,3,5	Form
11 Parent Program Fidelity 7th Grade Sessions 5 Attachment R - Parent+Pgrm+Fidelity+7thGr+Session5.docx	Form
Attachment Z2 - Student+Program+Fidelity+7th+Grade+Session+1.docx Attachment Z2 - Student+Program+Fidelity+7th+Grade+Session+1	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.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	11	Parent Program Fidelity 7th Grade Sessions 5	Attachment R - Parent+Pgrm+Fidelity+7thGr+Session5.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 168

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 20 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	504	504
Annual IC Time Burden (Hours)	126	126
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment Z2 - Student+Program+Fidelity+7th+Grade+Session+1	Attachment Z2 - Student+Program+Fidelity+7th+Grade+Session+1.docx	10/24/2011

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