Healthy and Safe School Environment

School Health Policies and Practices Study 2012

Documents and Forms

Document Name Document Type
Appendix G-5 Healthy and Safe Environment School.doc Other-WORD
Appendix E-1 School Participant Notification Document.docx Appendix E-1 School Participant Notification Document IC Document
Appendix H-7 School- and Classroom-level Content Outlines.doc Appendix H-7 School- and Classroom-level Content Outlines IC Document

Information Collection (IC) Details

IC Title:	Healthy and Safe School Environment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			Appendix G-5 Healthy and Safe Environment School.doc		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 640	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	640	640
Annual IC Time Burden (Hours)	960	960
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix E-1 School Participant Notification Document	Appendix E-1 School Participant Notification Document.docx	06/24/2013
Appendix H-7 School- and Classroom-level Content Outlines	Appendix H-7 School- and Classroom-level Content Outlines.doc	06/24/2013

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