Information Collection

Evaluation of the Early Warning and Intervention Monitoring System (EWIMS)

IC 209355 under ICR 201311-1850-002 · OMB 1850-0904.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
I-1 Draft School Survey.pdf	Other-School Survey
I-2 Draft School Data Culture Survey.pdf	Other-Culture Survey
I-3 EWS tool Data Collection Protocol.pdf	Other-Protocol
I-4 Survey Consent.pdf	Other-Consent
I-5 Interview Consent.pdf	Other-Interview Consent
I-6 Draft EWIMS Interview Protocol.pdf	Other-Interview
I-7 Draft EWIMS Team Meeting Log.pdf	Other-Meeting Log
R-2 Study Overview IN.pdf	Other-Overview IN
R-2 Study Overview MI.pdf	Other-Overview MI
R-2 Study Overview OH.pdf	Other-Overview OH
R-5 School Screening.pdf	Other-Screening
R-4 Follow Up Email.pdf	Other-Follow-up email
R-6 District Screening.pdf	Other-Screening
R-7 School MOU.pdf	Other-MOU
R-8 District MOU.pdf	Other-MOU
R-9 State MOU.pdf	Other-MOU

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-School Survey	I-1 Draft School Survey.pdf	Yes	Yes	Paper Only
Other-Culture Survey	I-2 Draft School Data Culture Survey.pdf	Yes	Yes	Paper Only
Other-Protocol	I-3 EWS tool Data Collection Protocol.pdf	Yes	Yes	Paper Only
Other-Consent	I-4 Survey Consent.pdf	Yes	Yes	Fillable Fileable
Other-Interview Consent	I-5 Interview Consent.pdf	Yes	Yes	Fillable Fileable
Other-Interview	I-6 Draft EWIMS Interview Protocol.pdf	No		Paper Only
Other-Meeting Log	I-7 Draft EWIMS Team Meeting Log.pdf	Yes	Yes	Fillable Fileable
Other-Overview IN	R-2 Study Overview IN.pdf	Yes	Yes	Fillable Fileable
Other-Overview MI	R-2 Study Overview MI.pdf	Yes	Yes	Fillable Fileable
Other-Overview OH	R-2 Study Overview OH.pdf	Yes	Yes	Fillable Fileable
Other-Screening	R-5 School Screening.pdf	Yes	Yes	Fillable Fileable
Other-Follow-up email	R-4 Follow Up Email.pdf	Yes	Yes	Fillable Fileable
Other-Screening	R-6 District Screening.pdf	Yes	Yes	Fillable Fileable
Other-MOU	R-7 School MOU.pdf	Yes	Yes	Fillable Fileable
Other-MOU	R-8 District MOU.pdf	Yes	Yes	Fillable Fileable
Other-MOU	R-9 State MOU.pdf	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 702

Number of Respondents for Small Entity: 230

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	839	839
Annual IC Time Burden (Hours)	1,772	1,772
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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