Information Collection

Consolidated State Application

IC 21256 under ICR 201605-1810-008 · OMB 1810-0576.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1810-0576 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Consolidated State Application	Form and Instruction
State Plan Assuarances Template State Plan Assurances Template - Final.docx	Form and Instruction
ESSA State Plan Template ESSA state plan template 5.25.16.docx	Form and Instruction
assessguid15.pdf Assessment Peer Review guidance	IC Document

IC Title:

Consolidated State Application

Agency IC Tracking Number:

1810-AB27

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation: 34 CFR 299.13-19 34 CFR 200.2-6 34 CFR 200.8-9

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	NA	State Plan Assuarances Template	State Plan Assurances Template - Final.docx		Yes	Yes	Fillable Fileable
Form and Instruction	NA	ESSA State Plan Template	ESSA state plan template 5.25.16.docx		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: 52

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Previously Approved
Annual Number of Responses for this IC	52	22	30
Annual IC Time Burden (Hours)	117,373	114,973	2,400
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Assessment Peer Review guidance	assessguid15.pdf	05/31/2016

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