Information Collection

Drug-Free Communities (DFC) Support Program National Evaluation

IC 199117 under ICR 201508-3201-001 · OMB 3201-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3201-0012 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 7 Drug-Free Communities (DFC) Support Program National Evaluation	Form and Instruction
FINAL Attachment 4_ Sample Evaluation Report.pdf	Other-Sample Evaluation Report
FINAL Attachment 8_Site Visit Protocols proposed changes.docx	Instruction
FINAL Attachment 10_Sample Survey Review Guide.docx	Instruction
FINAL Attachment 12_Site Visit Protocols.docx	Instruction
DFCMe_Wireframes_October 2015.pdf	Other-Wireframes
Attachment 6 Progress Report Proposed Data Collection Revisions FINAL Attachment 6_Progress Report proposed changes.doc	Form and Instruction
Attachment 7 CCT Proposed Data Collection Revisions FINAL Attachment 7_CCT_Proposed Changes.doc	Form and Instruction
Attachment 9 Progress Report and Core Measures Data Collection Final FINAL Attachment 9_Progress Report and Core Measure Data Collection.doc	Form and Instruction
Attachment 11 Final Revised CCT Data Collection Instrument FINAL Attachment 11_CCT.doc	Form and Instruction
Attachment 16 DFC Management and Evaluattion (DFC Me) Wireframes DFCMe_Wireframes_20150708.pdf	Form and Instruction
Attachment 13: Pro Attachment 13: Proposed Feedback Evaluation Items FINAL Attachment 13_Proposed Feedback Evaluation Items.docx	Form and Instruction
Attachment 14: Req Attachment 14: Requests for Access to DFC Data FINAL Attachment 14_Data Request Form.docx	Form and Instruction
FINAL Attachment 3_Evaluation Plan .docx DFC Evaluation Plan	IC Document
Estimates of Hour Burden Including Annualized Hourly Cost.docx Estimates of Hour Burden Including Annualized Hourly Cost	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Drug-Free Communities (DFC) Support Program National Evaluation

Agency IC Tracking Number:

3201-0012

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 1 CFR 21 USC 1702

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 and Instruction	Attachment 7	CCT Proposed Data Collection Revisions	FINAL Attachment 7_CCT_Proposed Changes.doc		Yes	Yes	Fillable Fileable
Instruction			FINAL Attachment 8_Site Visit Protocols proposed changes.docx		No		Paper Only
Form and Instruction	Attachment 9	Progress Report and Core Measures Data Collection Final	FINAL Attachment 9_Progress Report and Core Measure Data Collection.doc		Yes	Yes	Fillable Fileable
Instruction			FINAL Attachment 10_Sample Survey Review Guide.docx		No		Printable Only
Form and Instruction	Attachment 11	Final Revised CCT Data Collection Instrument	FINAL Attachment 11_CCT.doc		Yes	Yes	Fillable Fileable
Instruction			FINAL Attachment 12_Site Visit Protocols.docx		No		Paper Only
Form and Instruction	Attachment 16	DFC Management and Evaluattion (DFC Me) Wireframes	DFCMe_Wireframes_20150708.pdf		Yes	Yes	Fillable Fileable
Other-Sample Evaluation Report			FINAL Attachment 4_ Sample Evaluation Report.pdf		Yes	Yes	Printable Only
Form and Instruction	Attachment 6	Progress Report Proposed Data Collection Revisions	FINAL Attachment 6_Progress Report proposed changes.doc		Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 14: Requests for Access to DFC Data	Attachment 14: Requests for Access to DFC Data	FINAL Attachment 14_Data Request Form.docx	TBD	Yes	Yes	Fillable Printable
Other-Wireframes			DFCMe_Wireframes_October 2015.pdf	TBD	Yes	Yes	Fillable Printable
Form and Instruction	Attachment 13: Proposed Feedback Evaluation Items	Attachment 13: Proposed Feedback Evaluation Items	FINAL Attachment 13_Proposed Feedback Evaluation Items.docx	TBD	Yes	Yes	Fillable Printable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,495

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,495	-1,012	2,507
Annual IC Time Burden (Hours)	5,947	-4,025	9,972
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DFC Evaluation Plan	FINAL Attachment 3_Evaluation Plan .docx	08/07/2015
Estimates of Hour Burden Including Annualized Hourly Cost	Estimates of Hour Burden Including Annualized Hourly Cost.docx	08/07/2015

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