Information Collection

21st CCLC facilitator survey

IC 227154 under ICR 202211-3137-009 · OMB 3137-0108.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 21st CCLC facilita 21st CCLC facilitator survey	Form and Instruction
Form 21st CCLC facilita 21st CCLC facilitator survey form1 21st CCLC facilitator survey	Form and Instruction
21st CCLC facilita 21st CCLC facilitator survey form1 Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Faciltator online survey instrument Final 20170602.docx	Form and Instruction
21st CCLC facilita 21st CCLC facilitator survey form1 Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Faciltator online survey instrument Final 20170602.docx	Form and Instruction
Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Facilitator online survey reminder email Final 20170602.docx 21st CCLC facilitator survey email reminder	IC Document
Maker STEM Ed Support for 21st CCLC evaluation_5 17 17 - Facilitator online survey reminder email Final 20170602.docx 21st CCLC facilitator survey email reminder	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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 and Instruction	21st CCLC facilitator survey form 1				Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Cultural and Historic Exhibition

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 30

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	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	6	6
Annual IC Cost Burden (Dollars)	146	146

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
21st CCLC facilitator survey email reminder		06/12/2017

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

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