Educator Outcome Survey Baseline

Evaluation of Dating Matters: Strategies to Promote Healthy Teen Relationships

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0941 can be found here:

Documents and Forms

Document Name Document Type
Educator Outcome Survey Baseline Form and Instruction
Educator Outcome Survey (Baseline) Atmt_I_Educator_Outcome_Survey_Baseline[1].docx Form and Instruction
Atmt RRR Screen Shots Educator Survey_11-22-11 BT.doc Atmt RRR Screen Shots Educator Survey_11-22-11 BT IC Document

Information Collection (IC) Details

IC Title:	Educator Outcome Survey Baseline	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	Educator Outcome Survey (Baseline)	Atmt_I_Educator_Outcome_Survey_Baseline[1].docx		No	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,672	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	3,344	176	3,168
Annual IC Time Burden (Hours)	1,672	88	1,584
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Atmt RRR Screen Shots Educator Survey_11-22-11 BT	Atmt RRR Screen Shots Educator Survey_11-22-11 BT.doc	02/27/2012

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