School Health Policies and Practices Study 2012

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 26 Telephone Script for Recruitment and Respondent Identification: District	Form and Instruction	Modified	Available
Form 25 Health Education Classroom Questionnaire	Form and Instruction	New	Available
Form 24 Health Education Classroom Questionnaire	Form and Instruction	New	Repair queued
Form 26 School Physical Education and Activity	Form and Instruction	New	Available
Form 23 Faculty and Staff Health Promotion School Questionnaire	Form and Instruction	New	Available
Form 22 Mental Health and Social Services School Questionnaire	Form and Instruction	New	Available
Form 21 Healthy and Safe School Environment School Questionnaire	Form and Instruction	New	Repair queued
Form 20 Nutrition Services School Questionnaire	Form and Instruction	New	Available
Form 19 Health Services School Questionnaire	Form and Instruction	New	Available
Form 18 Physical Education and Activity School Questionnaire	Form and Instruction	New	Repair queued
Form 17 Health Education School Questionnaire	Form and Instruction	New	Available
Form 16 Telephone Script for Recruitment and Respondent Identifiction: School	Form and Instruction	New	Available
Form 15 Telephone Script For Recruitment and Respondent Identification: State	Form and Instruction	New	Available
Form 14 Mental Health and Social Services State Questionnaire	Form and Instruction	New	Available
Form 13 Healthy and Safe School Environment State Questionnaire	Form and Instruction	New	Available
Form 12 Nutrition Services State Questionnaire	Form and Instruction	New	Available
Form 11 Health Services State Questionnaire	Form and Instruction	New	Available
Form 10 Physical Education and Activity State Questionnaire	Form and Instruction	New	Available
Form 9 Health Education State Questionnaire	Form and Instruction	New	Available
Form 8 Faculty and Staff Health Promotion	Form and Instruction	New	Available
Form 7 Mental Health and Social Services District Questionnaire	Form and Instruction	New	Available
Form 6 Healthy and Safe School Environment District Questionnaire	Form and Instruction	New	Repair queued
Form 5 Nutrition Services District Questionnaire	Form and Instruction	New	Repair queued
Form 4 Health Services District Questionnaire	Form and Instruction	New	Available
Form 3 Physical Education and Activity District Questionnaire	Form and Instruction	New	Repair queued
Form 2 Health Education District Questionnaire	Form and Instruction	New	Available
SHPPS 2012 SS Part B_revised.docx	Supporting Statement B	Uploaded 2011-09-01	Available
Appendix K References.docx	Supplementary Document	Uploaded 2011-04-29	Available
APPENDIX F - Example Tables.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix D-2 - National Reviewers Directory.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix D-1 - Content Panel Participant.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix C - Healthy People 2020 Objectives Measured by SHPPS 2012.docx	Supplementary Document	Uploaded 2011-04-29	Available
Appendix A - Authorizing Legislation.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix I-4 Classroom-level Content Outlines.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix E-4 Classroom Participant Notification Document.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix E-3 School Participant Notification Document.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix I-1 - School Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix E-1 State Participant Notification Document-revised.docx	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-5 State-level Content Outlines.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-1 State Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-6 District-level Content Outlines.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix E-2 District Participant Notification Document.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix H-4 District Recruitment Script.doc	Supplementary Document	Uploaded 2011-04-29	Repair queued
Appendix I-3 School-level Content Outlines.doc	Supplementary Document	Uploaded 2011-05-04	Repair queued
Appendix E-3 School Participant Notification Document.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix I-1 - School Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix I-1 - School Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Repair queued
Appendix E-1 State Participant Notification Document-revised.docx	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-5 State-level Content Outlines.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-1 State Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-6 District-level Content Outlines.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix E-2 District Participant Notification Document.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix H-4 District Recruitment Script.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix I-1 - School Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix E-1 State Participant Notification Document-revised.docx	Supplementary Document	Uploaded 2011-05-02	Repair queued
Appendix H-5 State-level Content Outlines.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-1 State Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-6 District-level Content Outlines.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix E-2 District Participant Notification Document.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix H-4 District Recruitment Script.doc	Supplementary Document	Uploaded 2011-04-29	Repair queued
Appendix E-1 State Participant Notification Document-revised.docx	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-5 State-level Content Outlines.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-1 State Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-02	Available
Appendix H-6 District-level Content Outlines.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix E-2 District Participant Notification Document.doc	Supplementary Document	Uploaded 2011-04-29	Repair queued
Appendix H-4 District Recruitment Script.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix H-6 District-level Content Outlines.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix E-2 District Participant Notification Document.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix H-4 District Recruitment Script.doc	Supplementary Document	Uploaded 2011-04-29	Available
Appendix H-2 District Letter of Invitation.doc	Supplementary Document	Uploaded 2011-05-03	Repair queued
SS Part A rev.docx	Supporting Statement A	Uploaded 2011-09-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
6869	District Recruitment	Form and Instruction	Modified	Telephone Script for Recruitment and Respondent Identification: District
197640	Classroom Data Collection	Form and Instruction	New	Health Education Classroom Questionnaire
197640	Classroom Data Collection	Form and Instruction	New	Health Education Classroom Questionnaire
197639	School Data Collection	Form and Instruction	New	School Physical Education and Activity
197639	School Data Collection	Form and Instruction	New	Faculty and Staff Health Promotion School Questionnaire
197639	School Data Collection	Form and Instruction	New	Mental Health and Social Services School Questionnaire
197639	School Data Collection	Form and Instruction	New	Healthy and Safe School Environment School Questionnaire
197639	School Data Collection	Form and Instruction	New	Nutrition Services School Questionnaire
197639	School Data Collection	Form and Instruction	New	Health Services School Questionnaire
197639	School Data Collection	Form and Instruction	New	Physical Education and Activity School Questionnaire
197639	School Data Collection	Form and Instruction	New	Health Education School Questionnaire
197638	School Recruitment	Form and Instruction	New	Telephone Script for Recruitment and Respondent Identifiction: School
197637	State Recruitment and Data Collection	Form and Instruction	New	Telephone Script For Recruitment and Respondent Identification: State
197637	State Recruitment and Data Collection	Form and Instruction	New	Mental Health and Social Services State Questionnaire
197637	State Recruitment and Data Collection	Form and Instruction	New	Healthy and Safe School Environment State Questionnaire
197637	State Recruitment and Data Collection	Form and Instruction	New	Nutrition Services State Questionnaire
197637	State Recruitment and Data Collection	Form and Instruction	New	Health Services State Questionnaire
197637	State Recruitment and Data Collection	Form and Instruction	New	Physical Education and Activity State Questionnaire
197637	State Recruitment and Data Collection	Form and Instruction	New	Health Education State Questionnaire
197636	District Data Collection	Form and Instruction	New	Faculty and Staff Health Promotion
197636	District Data Collection	Form and Instruction	New	Mental Health and Social Services District Questionnaire
197636	District Data Collection	Form and Instruction	New	Healthy and Safe School Environment District Questionnaire
197636	District Data Collection	Form and Instruction	New	Nutrition Services District Questionnaire
197636	District Data Collection	Form and Instruction	New	Health Services District Questionnaire
197636	District Data Collection	Form and Instruction	New	Physical Education and Activity District Questionnaire
197636	District Data Collection	Form and Instruction	New	Health Education District Questionnaire

ICR Details

OMB Control No: 0920-0445	ICR Reference No: 201105-0920-006
Status: Historical Active	Previous ICR Reference No: 200508-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: School Health Policies and Practices Study 2012
Type of Information Collection: Reinstatement with change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 09/02/2011
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/10/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2012	12 Months From Approved
Responses	6,196	0	0
Time Burden (Hours)	13,256	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests OMB approval to conduct a national study of school health policies and practices at the state, district, school, and classroom levels. Information will be collected in the spring of 2012.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 10368	02/24/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 24028	04/29/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Classroom Data Collection	24, 25	Health Education Classroom Questionnaire ,   Health Education Classroom Questionnaire
District Data Collection	2, 3, 4, 5, 6, 7, 8	Health Education District Questionnaire ,   Physical Education and Activity District Questionnaire ,   Health Services District Questionnaire ,   Nutrition Services District Questionnaire ,   Healthy and Safe School Environment District Questionnaire ,   Mental Health and Social Services District Questionnaire ,   Faculty and Staff Health Promotion
District Recruitment	26	Telephone Script for Recruitment and Respondent Identification: District
School Data Collection	17, 18, 19, 20, 21, 22, 23, 26	Health Education School Questionnaire ,   Physical Education and Activity School Questionnaire ,   Health Services School Questionnaire ,   Nutrition Services School Questionnaire ,   Healthy and Safe School Environment School Questionnaire ,   Mental Health and Social Services School Questionnaire ,   Faculty and Staff Health Promotion School Questionnaire ,   School Physical Education and Activity
School Recruitment	16	Telephone Script for Recruitment and Respondent Identifiction: School
State Recruitment and Data Collection	9, 10, 11, 12, 13, 14, 15	Health Education State Questionnaire ,   Physical Education and Activity State Questionnaire ,   Health Services State Questionnaire ,   Nutrition Services State Questionnaire ,   Healthy and Safe School Environment State Questionnaire ,   Mental Health and Social Services State Questionnaire ,   Telephone Script For Recruitment and Respondent Identification: State

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	6,196	0	0	6,196	0	0
Annual Time Burden (Hours)	13,256	0	0	13,256	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: CDC has conducted this study every six years since 1994. The next cycle of data collection is scheduled for 2012. A Reinstatement with changes is requested. Changes include the deletion of questions that did not provide useful data in 2006, minor modifications to question wording to improve clarity, a change in the mode of administration (from computer-assisted telephone interviewing to self-administered web-based questionnaires), a revision of the state-level questionnaires to no longer collect information about state-level policies since that information is available elsewhere, and the inclusion of vending machine observations

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Annual Cost to Federal Government: $7,202,990

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/10/2011

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