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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
DASH COVID-19 School Connectedness Formative Evaluation - Pilot Study
Agency IC Tracking Number:
0920-22IF
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
0920-22IF
Att2 SC Demo_KII Interview Guide
Att2 SC Demo_KII Interview Guide.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-22IF
Att3 SC Demo_Champion Focus Group Guide
Att3 SC Demo_Champion Focus Group Guide.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-22IF
Att4 SC Demo_Teacher Focus Group Guide
Att4 SC Demo_Teacher Focus Group Guide.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-22IF
Att5 SC Demo_Student Focus Group Guide
Att5 SC Demo_Student Focus Group Guide.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
103
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
103
0
103
0
0
0
Annual IC Time Burden (Hours)
106
0
106
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Authorizing Leg.
Att1 Authorizing Legislation.docx
08/12/2022
Family Consent Form
Att6a Family Consent Form.docx
08/12/2022
Att6b Student Assent Form
Att6b Student Assent Form.docx
08/12/2022
Att9 60 Day FRN Published 2-12-2021
Att9 60 Day FRN Published 2-12-2021.pdf
08/12/2022
Att7 PIA SC Formative Evaluation Pilot Study
Att7 PIA SC Formative Evaluation Pilot Study.pdf
08/12/2022
SSA
SSA_rev.docx
08/12/2022
SSB
SSB.docx
08/12/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.