Johnson-O'Malley Student Count Form Pre-Test

DOI Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1090-0011 can be found here:

Documents and Forms

Document Name Document Type
JOM collection instrumnet for preliminary count.xlsx Other-Pre-Test Form
DI-4011 Fast Track Request Form--JOMml.pdf Request for Approval IC Document

Information Collection (IC) Details

IC Title:	Johnson-O'Malley Student Count Form Pre-Test	Agency IC Tracking Number:	2019-BIA-FT70

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
Other-Pre-Test Form			JOM collection instrumnet for preliminary count.xlsx		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 530	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	530	530
Annual IC Time Burden (Hours)	530	530
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval	DI-4011 Fast Track Request Form--JOMml.pdf	04/09/2019

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