Assessing "Return to Learn" Programs

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Assessing "Return to Learn" Programs Form
Return to Learn Assessment Att. B_Instrument__Survey Monkey 2016_5_11.docx Form
GenIC_Request _RTL EA_2016_5_12.docx Request for Approval IC Document
Att. A_Announcement_2016_5_12.docx Survey Announcement IC Document

Information Collection (IC) Details

IC Title:	Assessing "Return to Learn" Programs	Agency IC Tracking Number:	16ALQ

IC Status: New

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	none	Return to Learn Assessment	Att. B_Instrument__Survey Monkey 2016_5_11.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 50	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	GenIC_Request _RTL EA_2016_5_12.docx	05/18/2016
Survey Announcement	Att. A_Announcement_2016_5_12.docx	05/18/2016

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