Teachers Data Collection Checklist

Study to Examine Web-based Administration of the Youth Risk Behavior Survey

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Teachers Data Collection Checklist	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-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 %

	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

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.