Information Collection

21st CCLC youth interview

IC 227156 under ICR 201706-3137-001 · OMB 3137-0108.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21st CCLC youth in 21st CCLC youth interview	Form and Instruction
21st CCLC youth in 21st CCLC youth interview form 1 Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Youth participant interview protocol Final 20170602.docx	Form and Instruction
Maker STEM Ed Support for 21st CCLC evaluation 6.2.17 - Youth participant interview consent form.docx 21st CCLC youth interview - parental permission form	IC Document

IC Title:

21st CCLC youth interview

Agency IC Tracking Number:

Is this a Common Form? No

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
Form and Instruction	21st CCLC youth interview form 1	21st CCLC youth interview form 1	Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Youth participant interview protocol Final 20170602.docx		No		Paper Only

Line of Business: Education

Subfunction: Cultural and Historic Exhibition

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	48	48
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
21st CCLC youth interview - parental permission form	Maker STEM Ed Support for 21st CCLC evaluation 6.2.17 - Youth participant interview consent form.docx	06/12/2017

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