Information Collection

Subminimum Wage to Competitive Integrated Employment Program Evaluation

IC 267353 under ICR 202404-1820-002 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Subminimum Wage to Competitive Integrated Employment Program Evaluation	Form
Site Visit Participant Interviews AppA_Site Visit Topic Guides_SWTCIE Participant Interviews_clean 10.3.24.docx	Form
Site Visit Caregiver Focus Group AppB_Site Visit Topic Guides_Caregiver Focus Group_clean 10.3.24.docx	Form
Site Visit Implementation Partners AppC_Site Visit Topic Guides_SWTCIE Implementation Partners_clean 10.3.24.docx	Form
Site Visit Staff Focus Group AppD_Site Visit Topic Guides_SWTCIE Staff Focus Group_clean 10.3.24.docx	Form
Site Visit CIE Employers AppE_Site Visit Topic Guides_CIE Employers_clean 10.3.24.docx	Form
Site Visit 14c Certificate Holders AppF_Site Visit Topic Guides_14c Certificate Holders_clean 10.3.24.docx	Form
Consent Form AppG_Consent Form CLEAN 10.3.24.docx	Form
Baseline Survey AppH_Baseline survey CLEAN 10.3.24.docx	Form
Participant Follow up Survey AppI_Participant follow-up survey CLEAN 10.3.24.docx	Form
DIF Staff Records AppJ_DIF staff records_clean 10.3.24.xlsx	Form
Project Cost and Data Collection Guide AppK_DIF project cost data collection guide_clean 10.3.24.xlsx	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	NA	Site Visit Participant Interviews	AppA_Site Visit Topic Guides_SWTCIE Participant Interviews_clean 10.3.24.docx	No		Paper Only
Form	NA	Site Visit Caregiver Focus Group	AppB_Site Visit Topic Guides_Caregiver Focus Group_clean 10.3.24.docx	No		Paper Only
Form	NA	Site Visit Implementation Partners	AppC_Site Visit Topic Guides_SWTCIE Implementation Partners_clean 10.3.24.docx	No		Paper Only
Form	NA	Site Visit Staff Focus Group	AppD_Site Visit Topic Guides_SWTCIE Staff Focus Group_clean 10.3.24.docx	No		Paper Only
Form	NA	Site Visit CIE Employers	AppE_Site Visit Topic Guides_CIE Employers_clean 10.3.24.docx	No		Paper Only
Form	NA	Site Visit 14c Certificate Holders	AppF_Site Visit Topic Guides_14c Certificate Holders_clean 10.3.24.docx	No		Paper Only
Form	NA	Consent Form	AppG_Consent Form CLEAN 10.3.24.docx	No		Paper Only
Form	NA	Baseline Survey	AppH_Baseline survey CLEAN 10.3.24.docx	Yes	Yes	Fillable Fileable
Form	NA	Participant Follow up Survey	AppI_Participant follow-up survey CLEAN 10.3.24.docx	Yes	Yes	Fillable Fileable
Form	NA	DIF Staff Records	AppJ_DIF staff records_clean 10.3.24.xlsx	Yes	Yes	Fillable Fileable
Form	NA	Project Cost and Data Collection Guide	AppK_DIF project cost data collection guide_clean 10.3.24.xlsx	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: 13,366

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Requested	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate
Annual Number of Responses for this IC	4,866	0	4,866	0
Annual IC Time Burden (Hours)	2,224	2,005	0	219
Annual IC Cost Burden (Dollars)	0	0	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.