Information Collection

State Survey and District Survey

IC 256586 under ICR 202210-1850-005 · OMB 1850-0977.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
State Survey and District Survey	Form
Title III State Survey Title III State Survey.docx	Form
Title III State Survey Title III State Survey.docx	Form
Title III District Survey Appendix B Title III District survey 02-28-2023.docx	Form
Title III District Survey Appendix B Title III District survey 02-28-2023.docx	Form
Notification Materials.docx Notification Materials	IC Document
Notification Materials.docx Notification Materials	IC Document

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	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Title III State Survey	Title III State Survey.docx		Yes	Yes	Fillable Fileable
Form	N/A	Title III District Survey	Appendix B Title III District survey 02-28-2023.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: 1,267

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	422	422
Annual IC Time Burden (Hours)	317	317
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Notification Materials	Notification Materials.docx	02/27/2023

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