Information Collection

Teachers Data Collection Checklist

IC 182578 under ICR 200711-0920-001 · OMB 0920-0763.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix J - Data Collection Checklist for the Student Heatlh Survey.pdf	Other-Data Collection Checklist
Appendix K - Data Collection Checklist for the Student Health Survey Supplemental Documents.doc Student Health Survey	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-Data Collection Checklist			Appendix J - Data Collection Checklist for the Student Heatlh Survey.pdf		No	No	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 320

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	320	320
Annual IC Time Burden (Hours)	80	80
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Student Health Survey	Appendix K - Data Collection Checklist for the Student Health Survey Supplemental Documents.doc	10/03/2007

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