Information Collection

National Study to Inform the 21st Century Community Learning Centers (CCLC) Program

IC 245710 under ICR 202102-1850-003 · OMB 1850-0964.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
APPENDIX B_Afterschool Center Coaching Log.docx	Other-Afterschool Center Director/St
APPENDIX B_Afterschool Center Coaching Log.docx	Other-Afterschool Center Director/St
APPENDIX C_Request for Student Afterschool Attendance Records.docx	Other-Afterschool Center Student Att
APPENDIX C_Request for Student Afterschool Attendance Records.docx	Other-Afterschool Center Student Att
APPENDIX D_Parent or Guardian Questionnaire_redacted.docx	Other-Parent/Guardian Questionnaire
APPENDIX D_Parent or Guardian Questionnaire_redacted.docx	Other-Parent/Guardian Questionnaire
APPENDIX E_Parent or Guardian Permission Form 4 27 2021.docx	Other-Parent/Guardian Permission For
APPENDIX E_Parent or Guardian Permission Form 4 27 2021.docx	Other-Parent/Guardian Permission For

IC Title:

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	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Afterschool Center Director/Staff Coaching Log	APPENDIX B_Afterschool Center Coaching Log.docx	Yes	Yes	Fillable Fileable
Other-Afterschool Center Student Attendance Records Request	APPENDIX C_Request for Student Afterschool Attendance Records.docx	Yes	Yes	Fillable Fileable
Other-Parent/Guardian Questionnaire	APPENDIX D_Parent or Guardian Questionnaire_redacted.docx	Yes	Yes	Fillable Fileable
Other-Parent/Guardian Permission Form	APPENDIX E_Parent or Guardian Permission Form 4 27 2021.docx	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,228

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
Annual Number of Responses for this IC	1,228	1,228
Annual IC Time Burden (Hours)	397	397
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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