Information Collection

Student Health Survey

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

Documents and Forms

Documents and forms in this information collection
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

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.