Information Collection

State Recruitment and Data Collection

IC 197637 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⚠️ Notice: This information collection may be referencing outdated material.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 15 State Recruitment and Data Collection	Form and Instruction
9 Health Education State Questionnaire Appendix G-1 Health Education_State.doc	Form and Instruction
10 Physical Education and Activity State Questionnaire Appendix G-2 Physical Education_State.doc	Form and Instruction
11 Health Services State Questionnaire Appendix G-3 Health Services_State.doc	Form and Instruction
12 Nutrition Services State Questionnaire Appendix G-4 Nutrition Services_State.doc	Form and Instruction
13 Healthy and Safe School Environment State Questionnaire Appendix G-5 Healthy&Safe Environment_State.doc	Form and Instruction
14 Mental Health and Social Services State Questionnaire Appendix G-6 MHSS_State.doc	Form and Instruction
15 Telephone Script For Recruitment and Respondent Identifi Appendix H-3 State Recruitment Script.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
Appendix H-1 State Letter of Invitation.doc Appendix H-1 State Letter of Invitation	IC Document
Appendix H-5 State-level Content Outlines.doc Appendix H-5 State-level Content Outlines	IC Document
Appendix E-1 State Participant Notification Document-revised.docx Appendix E-1 State Participant Notification Document-revised	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

State Recruitment and 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	15	Telephone Script For Recruitment and Respondent Identification: State	Appendix H-3 State Recruitment Script.doc	Yes	Yes	Fillable Fileable
Form and Instruction	9	Health Education State Questionnaire	Appendix G-1 Health Education_State.doc	Yes	Yes	Fillable Fileable
Form and Instruction	10	Physical Education and Activity State Questionnaire	Appendix G-2 Physical Education_State.doc	Yes	Yes	Fillable Fileable
Form and Instruction	11	Health Services State Questionnaire	Appendix G-3 Health Services_State.doc	Yes	Yes	Fillable Fileable
Form and Instruction	12	Nutrition Services State Questionnaire	Appendix G-4 Nutrition Services_State.doc	Yes	Yes	Fillable Fileable
Form and Instruction	13	Healthy and Safe School Environment State Questionnaire	Appendix G-5 Healthy&Safe Environment_State.doc	Yes	Yes	Fillable Fileable
Form and Instruction	14	Mental Health and Social Services State Questionnaire	Appendix G-6 MHSS_State.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: 51

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	51	51
Annual IC Time Burden (Hours)	204	204
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
Appendix H-1 State Letter of Invitation	Appendix H-1 State Letter of Invitation.doc	05/02/2011
Appendix H-5 State-level Content Outlines	Appendix H-5 State-level Content Outlines.doc	05/02/2011
Appendix E-1 State Participant Notification Document-revised	Appendix E-1 State Participant Notification Document-revised.docx	05/02/2011

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