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

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 D-2 (HIV LEA FY2011).docx Other-WORD
Attachment D-1 (HIV LEA FY2010).doc Other-WORD
684 Form.pdf 684 Form IC Document

Information Collection (IC) Details

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

	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

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.