Information Collection

School Associated Violent Deaths Surveillance System

IC 7069 under ICR 201001-0920-006 · OMB 0920-0604.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Attachment 6 Data Collection Instrument.doc	Instruction
Attachment 10.Parental Consent Form.doc	Instruction
Attachment 9.Telephone Consent Script.doc	Instruction

IC Title:

School Associated Violent Deaths Surveillance System

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Yes	Yes	Printable Only
Instruction	Yes	Yes	Printable Only
Instruction	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 35

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	35	-35	70
Annual IC Time Burden (Hours)	35	-35	70
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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

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