Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Student Program Fidelity 6th Grade Sessions 1 - 6 Unchanged 480 120 0 Form and Instruction V Student Program Fidelity 6th Grade Session 2
Form and Instruction U Student Program Fidelity 6th Grade Session 1
Form and Instruction W Student Program Fidelity 6th Grade Session 3
Form and Instruction X Student Program Fidelity 6th Grade Session 4
Form and Instruction Y Student Program Fidelity 6th Grade Session 5
Form and Instruction Z Student Program Fidelity 6th Grade Session 6
Student Program Fidelity 7th Grade Sessions 1 - 7 Unchanged 560 140 0 Form and Instruction AA Student Program Fidelity 7th Grade Session 1
Form and Instruction BB Student Program Fidelity 7th Grade Session 2
Form and Instruction CC Student Program Fidelity 7th Grade Session 3
Form and Instruction DD Student Program Fidelity 7th Grade Session 4
Form and Instruction EE Student Program Fidelity 7th Grade Session 5
Form and Instruction FF Student Program Fidelity 7th Grade Session 6
Form and Instruction GG Student Program Fidelity 7th Grade Session 7
Student Program Fidelity 8th Grade Sessions 1 - 10 Unchanged 800 200 0 Form and Instruction HH Student Program Fidelity 8th Grade Session 1
Form and Instruction II Student Program Fidelity 8th Grade Session 2
Form and Instruction JJ Student Program Fidelity 8th Grade Session 3
Form and Instruction KK Student Program Fidelity 8th Grade Session 4
Form and Instruction LL Student Program Fidelity 8th Grade Session 5
Form and Instruction MM Student Program Fidelity 8th Grade Session 6
Form and Instruction NN Student Program Fidelity 8th Grade Session 7
Form and Instruction OO Student Program Fidelity 8th Grade Session 8
Form and Instruction PP Student Program Fidelity 8th Grade Session 9
Form and Instruction QQ Student Program Fidelity 8th Grade Session 10
Communications Campaign Tracking Unchanged 16 5 0 Form and Instruction None Communications Campaign Tracking Form
Local Health Department Capacity and Readiness Unchanged 16 32 0 Form None Local Health Department Capacity and Readiness
Student Participant Focus Group Unchanged 80 120 0 Instruction
Instruction
Student Curricula Implementer Focus Group Guide Unchanged 80 80 0 Form and Instruction OOO Student Curricula Implementer Consent Form For Focus Group Participation
Other-Focus Group Guide
Parent Curricula Implementer Focus Group Guide Unchanged 80 80 0 Form and Instruction PPP Parent Curricula Implementer Consent Form for Focus Group Participation
Other-Focus Group Guide
Student Program Fidelity 8th Grade Sessions 1 - 10 (Standard) Unchanged 800 200 0 Form and Instruction DDD Student Program Fidelity 8th Grade Session 2
Form and Instruction EEE Student Program Fidelity 8th Grade Session 3
Form and Instruction CCC Student Program Fidelity 8th Grade Session 1 (Standard)
Form and Instruction FFF Student Program Fidelity 8th Grade Session 4
Form and Instruction GGG Student Program Fidelity 8th Grade Session 5
Form and Instruction HHH Student Program Fidelity 8th Grade Session 6
Form and Instruction III Student Program Fidelity 8th Grade Session 7
Form and Instruction KKK Student Program Fidelity 8th Grade Session 9
Form and Instruction JJJ Student Program Fidelity 8th Grade Session 8
Form and Instruction LLL Student Program Fidelity 8th Grade Session 10
STUDENT PROGRAM MASTER TRAINER TECHNICAL ASSISTANCE TRACKING FORM Unchanged 600 100 0 Form None Master Trainer TA Tracking Form
Educator Outcome Evaluation Survey-Follow-up Unchanged 1584 792 0 Form and Instruction none Educator Outcome Survey Follow-up
Community Capacity/Readiness Assessment Unchanged 80 80 0 Form and Instruction none Community Capacity/Readiness Assessment
Communications Focus Groups Unchanged 96 144 0 Instruction
Instruction
Parent Program Manager TA Tracking Form Unchanged 200 33 0 Form none Parent Program Manager (PPM) Technical Assistance Tracking form
6th Grade Curricula Parent Satisfaction Questionnaire Unchanged 1890 315 0 Form and Instruction none Parents Matter! for Dating Matters: Participant Satisfaction Questionnaire
7th Grade Curricula Parent Satisfaction Questionnaire Unchanged 1890 315 0 Form and Instruction none Dating Matters for Parents: Participant Satisfaction Questionnaire
Instruction
Student Outcome Survey Baseline Unchanged 11286 8465 0 Form and Instruction None Student Outcome Survey Baseline
Student Outcome Survey Follow-up - High School Unchanged 10692 8910 0 Form none Student Outcome Survey
School Indicators Unchanged 15048 3762 0 Form and Instruction 4 Attachment G: School Indicators
Parent Outcome Baseline Survey Unchanged 1919 1919 0 Form and Instruction none Parent/Guardian Survey
Parent Outcome Follow-up Survey Unchanged 1818 1818 0 Form and Instruction None Parent Outcome Survey Follow-up
Form and Instruction none Parent/Guardian Consent Form
Educator Outcome Survey Baseline Unchanged 1672 836 0 Form and Instruction None Educator Outcome Survey (Baseline)
Brand Ambassador Implementation Survey Unchanged 160 53 0 Form and Instruction None Brand Ambassador Implementation Survey
School Leadership Capacity and Readiness Survey Unchanged 42 42 0 Form and Instruction None School Leadership Capacity and Readiness Survey
Parent Program Fidelity 6th Grade Sessions 1-6 Unchanged 630 158 0 Form M Parent Program Fidelity 6th Grade Session 2
Form N Parent Program Fidelity 6th Grade Session 3
Form O Parent Program Fidelity 6th Grade Session 5
Form Q Parent Program Fidelity 6th Grade Session 6
Form L Parent Program Fidelity 6th Grade Session 2
Parent Program Fidelity 7th Grade Sessions 1, 3, 5 Unchanged 378 95 0 Form T Parent Program Fidelity 7th Grade Session 5
Form R Parent Program Fidelity 7th Grade Session 1
Form S Parent Program Fidelity 7th Grade Session 3
Total burden requested under this ICR: 52897 28814 0  
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