Attendance Log

OMB Control No. 0985-0036
Exp. Date XX/XX/20XX

Your Program Name
Attendance Log
Instructions to Program Facilitators: Please clearly print the Program Information and the
Participant IDs below. Write participants’ IDs as they appear on their Participant Information
Surveys.
Mark each session that the participant attends like this:
Implementation Site Name: _________________________________
Start Date (mm/dd/yyyy):
End Date (mm/dd/yyyy):

/
/

/____
/ _ _ _ __

Participant Attendance Log
Session Number*

Participant ID
1
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.

2

3

4

5

6

OMB Control No. 0985-0036
Exp. Date XX/XX/20XX

17.
18.
19.
20.

*Adapt this section to include the number of possible sessions. Use additional pages if needed.

Public Burden Statement:
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of
information unless such collection displays a valid OMB control number (OMB 0985-0036). Public
reporting burden for this collection of information is estimated to average .20 hours per response, including
time for gathering and maintaining the data needed and completing and reviewing the collection of
information. The obligation to respond to this collection is voluntary.