Indicators for School Health Programs: HIV Prevention (for State Education Agencies)

Indicators of the Performance of Local, State, Territorial, and Tribal Education Agencies in HIV, Coordinated School Health and Asthma Management for Adolescent and School Health Programs

Documents and Forms

Document Name Document Type
Attachment C-1 (HIV SEA FY2010).docx Other-WORD
Attachment C-2 (HIV SEA FY2011).docx Other-WORD

Information Collection (IC) Details

IC Title:	Indicators for School Health Programs: HIV Prevention (for State Education Agencies)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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 C-1 (HIV SEA FY2010).docx		Yes	Yes	Fillable Printable
Other-WORD			Attachment C-2 (HIV SEA FY2011).docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 57	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 97 %

	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	57	2	55
Annual IC Time Burden (Hours)	399	14	385
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

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.