21st CCLC facilitator survey

Maker/STEM Education Support for 21st Century Community Learning Centers Program Evaluation

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3137-0108 can be found here:

Documents and Forms

Document Name Document Type
Form 21st CCLC facilita 21st CCLC facilitator survey Form and Instruction
21st CCLC facilita 21st CCLC facilitator survey form1 Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Faciltator online survey instrument Final 20170602.docx Form and Instruction
Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Facilitator online survey reminder email Final 20170602.docx 21st CCLC facilitator survey email reminder IC Document

Information Collection (IC) Details

IC Title:	21st CCLC facilitator survey	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	21st CCLC facilitator survey form 1	21st CCLC facilitator survey form1	Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Faciltator online survey instrument Final 20170602.docx		Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Exhibition

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	146	146

Documents for IC

Title	Document	Date Uploaded
21st CCLC facilitator survey email reminder	Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Facilitator online survey reminder email Final 20170602.docx	06/12/2017

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