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School Associated Violent Deaths Surveillance System
School Associated Violent Deaths Surveillance System
OMB: 0920-0604
IC ID: 7069
OMB.report
HHS/CDC
OMB 0920-0604
ICR 200611-0920-002
IC 7069
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:
2019-05-02 - Revision of a currently approved collection
2016-01-13 - Revision of a currently approved collection
Documents and Forms
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
Information Collection (IC) Details
View Information Collection (IC)
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:
Document Type
Form No.
Form Name
Instrument File
URL
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
Federal Enterprise Architecture Business Reference Module
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 %
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
70
0
0
0
0
70
Annual IC Time Burden (Hours)
70
0
0
0
0
70
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
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.