Information Collection

School Associated Violent Deaths Surveillance System

IC 7069 under ICR 200611-0920-002 · OMB 0920-0604.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB SAVD Att 10_Parental Consent Form 11-14-06 (2).doc	Other-Other
OMB SAVD Att 9_Telephone Consent Script 11-14-06 (2).doc	Other-Other
None assigned Att 5 - Data Collection Instrument OMB SAVD Att 5_Data Collection Instrument 11-14-06 (2).doc	Form and Instruction

IC Title:

School Associated Violent Deaths Surveillance System

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Other			OMB SAVD Att 10_Parental Consent Form 11-14-06 (2).doc	Yes	Yes	Printable Only
Form and Instruction	None assigned	Att 5 - Data Collection Instrument	OMB SAVD Att 5_Data Collection Instrument 11-14-06 (2).doc	Yes	Yes	Printable Only
Other-Other			OMB SAVD Att 9_Telephone Consent Script 11-14-06 (2).doc	Yes	Yes	Printable Only

Line of Business:

Subfunction:

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 70

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	70	70
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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