Information Collection

Screener and Interview Protocol

IC 234499 under ICR 201812-1850-002 · OMB 1850-0947.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1850-0947 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix A interview protocol final.docx	Other-Protocol
Appendix B Mathematica Confidentiality Pledge.pdf Confidentiality Pledge	IC Document
Appendix C Advance email 5.9.19.docx Email Confirmaiton	IC Document

IC Title:

Screener and Interview Protocol

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
Other-Protocol			Appendix A interview protocol final.docx		No		Paper Only

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 60

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

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	60	60
Annual IC Time Burden (Hours)	27	27
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Confidentiality Pledge	Appendix B Mathematica Confidentiality Pledge.pdf	05/14/2019
Email Confirmaiton	Appendix C Advance email 5.9.19.docx	05/14/2019

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