Information Collection

Att D - Indicators for School Health Programs: HIV Prevention, Local Education Agencies (FY2007)

IC 7140 under ICR 201104-0920-008 · OMB 0920-0672.

Documents and Forms

IC Title:

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:

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 D-2 (HIV LEA FY2011).docx		Yes	Yes	Fillable Printable
Other-WORD			Attachment D-1 (HIV LEA FY2010).doc		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 97 %

table that charts list of burden
	Approved	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	16	-1	17
Annual IC Time Burden (Hours)	112	-7	119
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
684 Form	684 Form.pdf	04/01/2011

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