State Sample Application

Green Ribbon Schools

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 1860-0509 can be found here:

Documents and Forms

Document Name Document Type
State Sample Application Form
Att_SampleStateApplication.doc Form
Att_SampleStateScoringRubric 2 6 12.docx Sample State Scoring Rubric IC Document

Information Collection (IC) Details

IC Title:	State Sample Application	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	N/A	N/A	Att_SampleStateApplication.doc		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: 58	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	58	58
Annual IC Time Burden (Hours)	1,450	1,450
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Sample State Scoring Rubric	Att_SampleStateScoringRubric 2 6 12.docx	02/16/2012

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