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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.