Information Collection

Survey Support from Teachers

IC 189797 under ICR 200907-0920-001 · OMB 0920-0832.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Survey Support from Teachers	Form
1 Data Collection Checklist - NYPANS Appendix J - Data Collection Checklist and Make-up List and Instructions.doc	Form
Appendix J1 - Letter to Teachers in Particpating Classes.doc Appendix J1 - Letter to Teachers in Particpating Classes	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
Form	1	Data Collection Checklist - NYPANS	Appendix J - Data Collection Checklist and Make-up List and Instructions.doc		No	No	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix J1 - Letter to Teachers in Particpating Classes	Appendix J1 - Letter to Teachers in Particpating Classes.doc	06/16/2009

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