Information Collection

Louis Stokes Alliance for Minority Participation Program (LSAMP) Evaluation - Staff Member

IC 275237 under ICR 202505-3145-003 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
AppendixStaffandDirectorInterviewProtocol.docx	Other-Interview Protocol
AppendixStaffandDirectorInterviewProtocol.docx	Other-Interview Protocol
LSAMP.StaffInterviewParticipationEmailText.docx LSAMP Staff Interview email	IC Document
LSAMP.StaffInterviewParticipationEmailText.docx LSAMP Staff Interview email	IC Document
LSAMP - Director and StaffInterviewConsentForm.docx LSAMP Staff Consent Form (also Director)	IC Document
LSAMP - Director and StaffInterviewConsentForm.docx LSAMP Staff Consent Form (also Director)	IC Document

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Interview Protocol					Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Higher Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	113	113
Annual IC Cost Burden (Dollars)	5,549	5,549

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
LSAMP Staff Interview email		05/12/2025
LSAMP Staff Consent Form (also Director)		05/12/2025

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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