OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Drug-Free Communities (DFC) Support Program National Evaluation

IC 199117 under ICR 202211-3201-001 · OMB 3201-0012.

Documents and Forms

Documents and forms in this information collection
Document NameDocument 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 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 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 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 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 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 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 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 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 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 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 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
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
1_Justification Statement_2019_Aug6.docx
Justification Statement - DFC		IC Document

Information Collection (IC) Details

View Information Collection (IC)

layout table

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 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


table that charts list of burden
  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 1,495 0 0 0 0 1,495
Annual IC Time Burden (Hours) 9,833 0 0 0 0 9,833
Annual IC Cost Burden (Dollars) 0 0 0 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.