Information Collection

Students (k-5)

IC 195202 under ICR 201011-0925-004 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form A Students (k-5)	Form and Instruction
A k-1 Form A Knowledge k-1 (2).docx	Form and Instruction
B k-1 attitudes Form B Attitudes k-1 (2).docx	Form and Instruction
C 2-3 Form C Knowledge 2-3 (2).docx	Form and Instruction
D 2-3 Form D Attitudes 2-3 (2).docx	Form and Instruction
E 4-5 Form E Knowledge 4-5.docx	Form and Instruction
F 4-5 Form F Attitudes 4-5.docx	Form and Instruction

IC Title:

Students (k-5)

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	A	k-1	Form A Knowledge k-1 (2).docx	Yes	Yes	Paper Only
Form and Instruction	B	k-1 attitudes	Form B Attitudes k-1 (2).docx	Yes	Yes	Paper Only
Form and Instruction	C	2-3	Form C Knowledge 2-3 (2).docx	Yes	Yes	Paper Only
Form and Instruction	D	2-3	Form D Attitudes 2-3 (2).docx	Yes	Yes	Paper Only
Form and Instruction	E	4-5	Form E Knowledge 4-5.docx	Yes	Yes	Paper Only
Form and Instruction	F	4-5	Form F Attitudes 4-5.docx	Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 375

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	375	375
Annual IC Cost Burden (Dollars)	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.