Information Collection

School Dismissal Monitoring System (Reporting Form)

IC 192337 under ICR 201003-0920-012 · OMB 0920-0849.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0849 can be found here:

Documents and Forms

Document Name Document Type
Attachment 4 School Dismissal Form.doc Other-WORD
Attachment 3 CDC School Guidance.pdf Attachment 3 CDC School Guidance IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	School Dismissal Monitoring System (Reporting Form)	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-WORD			Attachment 4 School Dismissal Form.doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 500	Number of Respondents for Small Entity: 5

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Change Due to Potential Violation of the PRA
Annual Number of Responses for this IC	500	500
Annual IC Time Burden (Hours)	42	42
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 3 CDC School Guidance	Attachment 3 CDC School Guidance.pdf	02/24/2010

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