Information Collection

Efficacy Evaluation of the Mathematics Intervention Toolkit for the Elementary Grades

IC 260489 under ICR 202306-1850-001 · OMB 1850-0987.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Efficacy Evaluation of the Mathematics Intervention Toolkit for the Elementary Grades	Form and Instruction
NE 5.1.3 MA Public Burden Statement.docx	Other-Burden Statement
NE 5.1.3 MA Public Burden Statement.docx	Other-Burden Statement
Parent/Guardian Informational Letter Parent_ConsentForm - Active 2023-08-14.docx	Form and Instruction
Parent/Guardian Informational Letter Parent_ConsentForm - Active 2023-08-14 ac_09-18-23.docx	Form and Instruction
Parent/Guardian Informational Letter (Parent/Guardian Op Parent_OptOut rev 2023-08-14.docx	Form and Instruction
Parent/Guardian Informational Letter (Parent/Guardian Op Parent_OptOut rev 2023-08-14 ac_09-18-23.docx	Form and Instruction
Teacher Consent Teacher_Consent.docx	Form and Instruction
Teacher Consent Teacher_Consent ac_09-18-23.docx	Form and Instruction
Student Survey Student Survey rev2.docx	Form and Instruction
Student Survey Student Survey rev2_09-18-23.docx	Form and Instruction
Teacher End-of-Module Reflection Survey Teacher End of Module Reflection Survey rev2.docx	Form and Instruction
Teacher End-of-Module Reflection Survey Teacher End of Module Reflection Survey rev2.docx	Form and Instruction
Teacher Math Knowledge for Teaching Assessment Teacher Math Knowledge for Teaching Assessment rev2.docx	Form and Instruction
Teacher Math Knowledge for Teaching Assessment Teacher Math Knowledge for Teaching Assessment rev2.docx	Form and Instruction
Teacher Post-Intervention Survey Teacher Post Intervention Survey rev2.docx	Form and Instruction
Teacher Post-Intervention Survey Teacher Post Intervention Survey rev2 ac_09-18-23.docx	Form and Instruction
Teacher Pre-Intervention Survey Teacher Pre Intervention Survey rev2.docx	Form and Instruction
Teacher Pre-Intervention Survey Teacher Pre Intervention Survey rev2 ac_09-18-23.docx	Form and Instruction
Teacher Instructional Log Teacher Instructional Log.docx	Form and Instruction
Teacher Instructional Log Teacher Instructional Log.docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Efficacy Evaluation of the Mathematics Intervention Toolkit for the Elementary Grades

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Parent/Guardian Informational Letter	Parent_ConsentForm - Active 2023-08-14 ac_09-18-23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Parent/Guardian Informational Letter (Parent/Guardian Opt-Out)	Parent_OptOut rev 2023-08-14 ac_09-18-23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Teacher Consent	Teacher_Consent ac_09-18-23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Student Survey	Student Survey rev2_09-18-23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Teacher End-of-Module Reflection Survey	Teacher End of Module Reflection Survey rev2.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Teacher Math Knowledge for Teaching Assessment	Teacher Math Knowledge for Teaching Assessment rev2.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Teacher Post-Intervention Survey	Teacher Post Intervention Survey rev2 ac_09-18-23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Teacher Pre-Intervention Survey	Teacher Pre Intervention Survey rev2 ac_09-18-23.docx	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Teacher Instructional Log	Teacher Instructional Log.docx	Yes	Yes	Fillable Fileable
Other-Burden Statement			NE 5.1.3 MA Public Burden Statement.docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 9,495

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
Annual Number of Responses for this IC	9,630	9,630
Annual IC Time Burden (Hours)	3,106	3,106
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.