Information Collection

Student Health Survey

IC 182576 under ICR 200711-0920-001 · OMB 0920-0763.

Documents and Forms

Document Name Document Type
Appendix E1 - Student Health Survey Without Skips.doc Other-Student Health Survey
Appendix E2 - Student Health Survey with Skip Patterns.doc Student Health Survey "With Skip Patterns" IC Document
Appendix G - Data Collection Instrument for Students Supplemental Documents.doc Student Health Survey "Supplemental Documents" IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Student Health Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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-Student Health Survey			Appendix E1 - Student Health Survey Without Skips.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6,000	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6,000	6,000
Annual IC Time Burden (Hours)	4,500	4,500
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Student Health Survey "With Skip Patterns"	Appendix E2 - Student Health Survey with Skip Patterns.doc	10/03/2007
Student Health Survey "Supplemental Documents"	Appendix G - Data Collection Instrument for Students Supplemental Documents.doc	10/03/2007

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