Health Behaviors in School-Age Children Survey

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 School Administrators	Form and Instruction	New	Available
SSB-0557.doc	Supporting Statement B	Uploaded 2008-11-10	Available
09-CH-N023 Approval Memo.pdf	Supplementary Document	Uploaded 2008-12-04	Available
09-CH-N023 IR.pdf	Supplementary Document	Uploaded 2008-12-04	Available
Attach 6.pdf	Supplementary Document	Uploaded 2008-11-10	Available
09-CH-N023 IR.pdf	Supplementary Document	Uploaded 2008-11-24	Available
09-CH-N023 Approval Memo.pdf	Supplementary Document	Uploaded 2008-11-24	Available
attach 4 (2).doc	Supplementary Document	Uploaded 2008-11-10	Available
Attach 3.xls	Supplementary Document	Uploaded 2008-11-10	Available
0557-SSA.doc	Supporting Statement A	Uploaded 2008-11-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7481	Adolescents	Instruction	Modified
187424	School Administrators	Form and Instruction	New

ICR Details

OMB Control No: 0925-0557	ICR Reference No: 200812-0925-001
Status: Historical Active	Previous ICR Reference No: 200511-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Health Behaviors in School-Age Children Survey
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/30/2009
	Date Received in OIRA: 12/04/2008
Terms of Clearance: Approved consistent with previous terms of clearance.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved	01/31/2009
Responses	15,058	0	14,790
Time Burden (Hours)	11,131	0	10,875
Cost Burden (Dollars)	0	0	0

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Abstract: A school-based survey of a national sample of school-age children (ages 11-15) to provide information on children's health and health behaviors and the factor associated with them and to permit national/international trends and comparisons.

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Authorizing Statute(s): US Code: 42 USC 285g Name of Law: Public Heath Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 53030	09/12/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 71012	11/24/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Adolescents	1	survey
School Administrators	1	survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	15,058	14,790	0	0	268	0
Annual Time Burden (Hours)	11,131	10,875	0	0	256	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/04/2008

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