Information Collection

District Data Collection

IC 197636 under ICR 201105-0920-006 · OMB 0920-0445.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0445 can be found here:

2013-07-09 - Reinstatement with change of a previously approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Health Education District Questionnaire District Data Collection	Form and Instruction
Form 3 Physical Education and Activity District Questionnaire District Data Collection	Form and Instruction
Form 4 Health Services District Questionnaire District Data Collection	Form and Instruction
Form 5 Nutrition Services District Questionnaire District Data Collection	Form and Instruction
Form 6 Healthy and Safe School Environment District Questionnaire District Data Collection	Form and Instruction
Form 7 Mental Health and Social Services District Questionnaire District Data Collection	Form and Instruction
Form 8 Faculty and Staff Health Promotion District Data Collection	Form and Instruction
2 Health Education District Questionnaire Appendix G-7 Health Education_District.doc	Form and Instruction
3 Physical Education and Activity District Questionnaire Appendix G-8 Physical Education_District.doc	Form and Instruction
4 Health Services District Questionnaire Appendix G-9 Health Services_District.doc	Form and Instruction
5 Nutrition Services District Questionnaire Appendix G-10 Nutrition Services_District.doc	Form and Instruction
6 Healthy and Safe School Environment District Questionnai Appendix G-11 Healthy&Safe Environment.doc	Form and Instruction
7 Mental Health and Social Services District Questionnaire Appendix G-12 MHSS_District.doc	Form and Instruction
8 Faculty and Staff Health Promotion Appendix G-13 FSHP_District.doc	Form and Instruction
Appendix H-4 District Recruitment Script.doc Appendix H-4 District Recruitment Script	IC Document
Appendix E-2 District Participant Notification Document.doc Appendix E-2 District Participant Notification Document	IC Document
Appendix H-6 District-level Content Outlines.doc Appendix H-6 District-level Content Outlines	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

District Data Collection

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	2	Health Education District Questionnaire	Appendix G-7 Health Education_District.doc	Yes	Yes	Fillable Fileable
Form and Instruction	3	Physical Education and Activity District Questionnaire	Appendix G-8 Physical Education_District.doc	Yes	Yes	Fillable Fileable
Form and Instruction	4	Health Services District Questionnaire	Appendix G-9 Health Services_District.doc	Yes	Yes	Fillable Fileable
Form and Instruction	5	Nutrition Services District Questionnaire	Appendix G-10 Nutrition Services_District.doc	Yes	Yes	Fillable Fileable
Form and Instruction	6	Healthy and Safe School Environment District Questionnaire	Appendix G-11 Healthy&Safe Environment.doc	Yes	Yes	Fillable Fileable
Form and Instruction	7	Mental Health and Social Services District Questionnaire	Appendix G-12 MHSS_District.doc	Yes	Yes	Fillable Fileable
Form and Instruction	8	Faculty and Staff Health Promotion	Appendix G-13 FSHP_District.doc	Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 685

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	685	685
Annual IC Time Burden (Hours)	2,854	2,854
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Appendix H-4 District Recruitment Script	Appendix H-4 District Recruitment Script.doc	04/29/2011
Appendix E-2 District Participant Notification Document	Appendix E-2 District Participant Notification Document.doc	04/29/2011
Appendix H-6 District-level Content Outlines	Appendix H-6 District-level Content Outlines.doc	04/29/2011

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