View Information Collection (IC)
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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
Drug-Free Communities (DFC) Support Program National Evaluation
Agency IC Tracking Number:
3201-0012
Is this a Common Form?
No
IC Status:
Modified
Obligation to Respond:
Mandatory
CFR Citation:
1 CFR 21 USC 1702
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Other-Sample Evaluation Report
FINAL Attachment 4_ Sample Evaluation Report.pdf
Yes
Yes
Printable Only
Form and Instruction
Attachment 6
Progress Report Proposed Data Collection Revisions
FINAL Attachment 6_Progress Report proposed changes.doc
Yes
Yes
Fillable Fileable
Form and Instruction
Attachment 7
CCT Proposed Data Collection Revisions
FINAL Attachment 7_CCT_Proposed Changes.doc
Yes
Yes
Fillable Fileable
Instruction
FINAL Attachment 8_Site Visit Protocols proposed changes.docx
No
Paper Only
Form and Instruction
Attachment 9
Progress Report and Core Measures Data Collection Final
FINAL Attachment 9_Progress Report and Core Measure Data Collection.doc
Yes
Yes
Fillable Fileable
Instruction
FINAL Attachment 10_Sample Survey Review Guide.docx
No
Printable Only
Form and Instruction
Attachment 11
Final Revised CCT Data Collection Instrument
FINAL Attachment 11_CCT.doc
Yes
Yes
Fillable Fileable
Instruction
FINAL Attachment 12_Site Visit Protocols.docx
No
Paper Only
Form and Instruction
Attachment 16
DFC Management and Evaluattion (DFC Me) Wireframes
DFCMe_Wireframes_20150708.pdf
Yes
Yes
Fillable Fileable
Other-Wireframes
DFCMe_Wireframes_October 2015.pdf
TBD
Yes
Yes
Fillable Printable
Form and Instruction
Attachment 13: Proposed Feedback Evaluation Items
Attachment 13: Proposed Feedback Evaluation Items
FINAL Attachment 13_Proposed Feedback Evaluation Items.docx
TBD
Yes
Yes
Fillable Printable
Form and Instruction
Attachment 14: Requests for Access to DFC Data
Attachment 14: Requests for Access to DFC Data
FINAL Attachment 14_Data Request Form.docx
TBD
Yes
Yes
Fillable Printable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Community and Social Services
Subfunction:
Community and Regional Development
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
1,495
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
1,495
0
-1,012
0
2,507
0
Annual IC Time Burden (Hours)
5,947
0
-4,025
0
9,972
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
DFC Evaluation Plan
FINAL Attachment 3_Evaluation Plan .docx
08/07/2015
Estimates of Hour Burden Including Annualized Hourly Cost
Estimates of Hour Burden Including Annualized Hourly Cost.docx
08/07/2015
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.