21st CCLC youth interview

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

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:

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 %

	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

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.