Information Collection

Drug-Free Communities (DFC) Support Program National Evaluation

IC 199117 under ICR 201909-3201-002 · OMB 3201-0012.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 3201-0012 can be found here:

2022-11-28 - Revision of a currently approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Attachment 4 Drug-Free Communities (DFC) Support Program National Evaluation	Form and Instruction
Attachment 4 Mockup of Progress Report and Core Measures Instrument Attachment 4_Proposed Revisions_Mockup of Progress Report and Core Measures_2019_July10.docx	Form and Instruction
Attachment 5 Coalition Classification Tool (CCT) Proposed Revisions Attachment 5_CCT_2019_Aug6_v2.doc	Form and Instruction
Attachment 6 Site Visit Protocols Attachment 6_Site Visit Protocols.docx	Form and Instruction
Attachment 8 Sample Survey Review Guide Attachment 8_Sample Survey Review Guide_10.29.18.docx	Form and Instruction
Attachment 9 Feedback Evaluation Items Attachment 9_Feedback Evaluation Items_10.29.18.docx	Form and Instruction
Attachment 7 Progress Report and Core Measures - CLEAN Attachment 7_ PR and CM Final_CleanCopy_2019_July_10.docx	Form and Instruction
Attachment 1_Authorization_10.29.18.pdf Attachment 1: Authorizations	IC Document
Attachment 2_Logic Model Evaluation Plan_10.29.18.docx Attachment 2: Logic Model Evaluation Plan	IC Document
Attachment 3_Sample_Evaluation_Report_EndYr2017_10.29.18.pdf Attachment 3: Sample Evaluation Report	IC Document
Attachment 10_DFC Data Sharing Request Form_10.29.18.docx Attachment 10: DFC Data Sharing Request Form	IC Document
Attachment 11_Federal Register 60Day and 30Day Notices.pdf Attachment 11: Federal Registry Notices	IC Document
Attachment 12_Overview of DFC Me system_draft_11.15.18.docx Attachment 12: Overview of DFC Me System	IC Document
1_Justification Statement_2019_Aug6.docx Justification Statement - DFC	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Drug-Free Communities (DFC) Support Program National Evaluation

Agency IC Tracking Number:

3201-0012

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Mandatory

CFR Citation: 1 CFR 21 Â§ USC 1702

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Attachment 4	Mockup of Progress Report and Core Measures Instrument	Attachment 4_Proposed Revisions_Mockup of Progress Report and Core Measures_2019_July10.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 5	Coalition Classification Tool (CCT) Proposed Revisions	Attachment 5_CCT_2019_Aug6_v2.doc	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 6	Site Visit Protocols	Attachment 6_Site Visit Protocols.docx	No		Paper Only
Form and Instruction	Attachment 8	Sample Survey Review Guide	Attachment 8_Sample Survey Review Guide_10.29.18.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 9	Feedback Evaluation Items	Attachment 9_Feedback Evaluation Items_10.29.18.docx	Yes	Yes	Fillable Fileable
Form and Instruction	Attachment 7	Progress Report and Core Measures - CLEAN	Attachment 7_ PR and CM Final_CleanCopy_2019_July_10.docx	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Community and Regional Development

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,495

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	1,495	0	1,495
Annual IC Time Burden (Hours)	9,833	3,886	5,947
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1: Authorizations	Attachment 1_Authorization_10.29.18.pdf	09/27/2019
Attachment 2: Logic Model Evaluation Plan	Attachment 2_Logic Model Evaluation Plan_10.29.18.docx	09/27/2019
Attachment 3: Sample Evaluation Report	Attachment 3_Sample_Evaluation_Report_EndYr2017_10.29.18.pdf	09/27/2019
Attachment 10: DFC Data Sharing Request Form	Attachment 10_DFC Data Sharing Request Form_10.29.18.docx	09/27/2019
Attachment 11: Federal Registry Notices	Attachment 11_Federal Register 60Day and 30Day Notices.pdf	09/27/2019
Attachment 12: Overview of DFC Me System	Attachment 12_Overview of DFC Me system_draft_11.15.18.docx	09/27/2019
Justification Statement - DFC	1_Justification Statement_2019_Aug6.docx	09/27/2019

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