Document Name Document Type
Providing Reading Interventions for Students in Middle School Toolkit Evaluation Form
Eligibility Questionnaire RELSW 5.1.6.4 PRISMS_OMB_Appendix A3_Eligibility Questionnaire v1.docx Form
Eligibility Questionnaire RELSW 5.1.6.4 PRISMS_OMB_Appendix A3_Eligibility Questionnaire v1.docx Form
Teacher Survey RELSW 5.1.6.4 PRISMS_OMB_Appendix B_Teacher Survey.docx Form
Teacher Survey RELSW 5.1.6.4 PRISMS_OMB_Appendix B_Teacher Survey.docx Form
Teacher Instructional Log RELSW 5.1.6.4 PRISMS_OMB_Appendix D_Teacher Instructional Log.docx Form
Teacher Instructional Log RELSW 5.1.6.4 PRISMS_OMB_Appendix D_Teacher Instructional Log.docx Form
Teacher Interview Questions RELSW 5.1.6.4 PRISMS_OMB_Appendix F_Teacher Interview Questions.docx Form
Teacher Interview Questions RELSW 5.1.6.4 PRISMS_OMB_Appendix F_Teacher Interview Questions.docx Form
School leader Interview Questions RELSW 5.1.6.4 PRISMS_OMB_Appendix G_School Leader Interview Questions.docx Form
School leader Interview Questions RELSW 5.1.6.4 PRISMS_OMB_Appendix G_School Leader Interview Questions.docx Form
School Leader Survey RELSW 5.1.6.4 PRISMS_OMB_Appendix H_School Leader Survey.docx Form
School Leader Survey RELSW 5.1.6.4 PRISMS_OMB_Appendix H_School Leader Survey.docx Form
Facilitator Checklist RELSW 5.1.6.4 PRISMS_OMB_Appendix J_Facilitator Checklist.docx Form
Facilitator Checklist RELSW 5.1.6.4 PRISMS_OMB_Appendix J_Facilitator Checklist.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Providing Reading Interventions for Students in Middle School Toolkit Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	Eligibility Questionnaire	RELSW 5.1.6.4 PRISMS_OMB_Appendix A3_Eligibility Questionnaire v1.docx	Yes	Yes	Fillable Fileable
Form	NA	Teacher Survey	RELSW 5.1.6.4 PRISMS_OMB_Appendix B_Teacher Survey.docx	Yes	Yes	Fillable Fileable
Form	NA	Teacher Instructional Log	RELSW 5.1.6.4 PRISMS_OMB_Appendix D_Teacher Instructional Log.docx	Yes	Yes	Fillable Fileable
Form	NA	Teacher Interview Questions	RELSW 5.1.6.4 PRISMS_OMB_Appendix F_Teacher Interview Questions.docx	Yes	Yes	Fillable Fileable
Form	NA	School leader Interview Questions	RELSW 5.1.6.4 PRISMS_OMB_Appendix G_School Leader Interview Questions.docx	Yes	Yes	Fillable Fileable
Form	NA	School Leader Survey	RELSW 5.1.6.4 PRISMS_OMB_Appendix H_School Leader Survey.docx	Yes	Yes	Fillable Fileable
Form	NA	Facilitator Checklist	RELSW 5.1.6.4 PRISMS_OMB_Appendix J_Facilitator Checklist.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: 669	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	2,647	2,647
Annual IC Time Burden (Hours)	851	851
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.

Providing Reading Interventions for Students in Middle School Toolkit Evaluation