Information Collection

Customer feedback interviews with state-level implementers of "Return to Learn"

IC 220543 under ICR 201405-0920-002 · OMB 0920-1009.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1009 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Instrument_GenIC_TBI_RTL022516.docx	Other-WORD
Att A_Invitation Email_GenIC_TBI_RTL.docx Invitation Email	IC Document
Request_GenIC_1009_TBI_RTL_022516.docx Request for Approval	IC Document

IC Title:

Customer feedback interviews with state-level implementers of "Return to Learn"

Agency IC Tracking Number:

16UK

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
Other-WORD			Instrument_GenIC_TBI_RTL022516.docx		No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	30	30
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Invitation Email	Att A_Invitation Email_GenIC_TBI_RTL.docx	03/09/2016
Request for Approval	Request_GenIC_1009_TBI_RTL_022516.docx	03/09/2016

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