Information Collection

Evaluation of A Toolkit to Support Evidence-Based Writing Instruction in Grades 2 Through 4

IC 262767 under ICR 202310-1850-001 · OMB 1850-0993.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Evaluation of A Toolkit to Support Evidence-Based Writing Instruction in Grades 2 Through 4	Form
Appendix I_Student Writing Sample Prompts and Rubrics_revised.docx	Other-Student Writing Sample Prompts
Appendix I_Student Writing Sample Prompts and Rubrics_revised.docx	Other-Student Writing Sample Prompts
Appendix M_District Administrative Records.docx	Other-District Administrative Record
Appendix M_District Administrative Records.docx	Other-District Administrative Record
Teacher Baseline Survey (Fall) Appendix B_Teacher Baseline Survey (Fall).docx	Form
Teacher Baseline Survey (Fall) Appendix B_Teacher Baseline Survey (Fall).docx	Form
Teacher Log (Fall and Spring) Appendix D_Teacher Log.docx	Form
Teacher Log (Fall and Spring) Appendix D_Teacher Log.docx	Form
PLC Post-Session Form Appendix F_PLC Facilitator Form_Post-Session.docx	Form
PLC Post-Session Form Appendix F_PLC Facilitator Form_Post-Session.docx	Form
PLC Final Implementation Form Appendix G_PLC Facilitator Form_Final Implementation.docx	Form
PLC Final Implementation Form Appendix G_PLC Facilitator Form_Final Implementation.docx	Form
Teacher Follow-Up Survey (Spring) Appendix C_Teacher Follow-Up Survey (Spring).docx	Form
Teacher Follow-Up Survey (Spring) Appendix C_Teacher Follow-Up Survey (Spring).docx	Form
Teacher Implementation Survey Appendix E_Teacher Implementation Survey.docx	Form
Teacher Implementation Survey Appendix E_Teacher Implementation Survey.docx	Form

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	Teacher Baseline Survey (Fall)	Appendix B_Teacher Baseline Survey (Fall).docx	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Log (Fall and Spring)	Appendix D_Teacher Log.docx	Yes	Yes	Fillable Fileable
Form	N/A	PLC Post-Session Form	Appendix F_PLC Facilitator Form_Post-Session.docx	Yes	Yes	Fillable Fileable
Form	N/A	PLC Final Implementation Form	Appendix G_PLC Facilitator Form_Final Implementation.docx	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Follow-Up Survey (Spring)	Appendix C_Teacher Follow-Up Survey (Spring).docx	Yes	Yes	Fillable Fileable
Form	N/A	Teacher Implementation Survey	Appendix E_Teacher Implementation Survey.docx	Yes	Yes	Fillable Fileable
Other-Student Writing Sample Prompts and Rubrics			Appendix I_Student Writing Sample Prompts and Rubrics_revised.docx	Yes	Yes	Fillable Fileable
Other-District Administrative Records			Appendix M_District Administrative Records.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: 1,047

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	4,188	4,188
Annual IC Time Burden (Hours)	1,237	1,237
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.