Information Collection

Elementary School Staff Questionnaire

IC 211263 under ICR 201404-0920-007 · OMB unassigned.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB_schools_AppendixD_Quest (2).docx	Other-WORD
OMB_schools_AppendixD2_Screen.docx	Other-Screenshots
OMB_schools_AppendixA_Law.docx App A Authorizing Legislation	IC Document
OMB_schools_AppendixB_FRN.docx App B 60d FRN	IC Document
OMB_schools_AppendixC_Review.docx App C External Review Comments	IC Document
OMB_schools_AppendixE_IRBLetter.docx App E IRB Approval Letter	IC Document
OMB_schools_AppendixF__Invitation.docx App F Inviatational Email and Consent	IC Document
OMB_schools_AppendixG.docx App G Fact Sheet	IC Document
OMB_schools_AppendixH_reminder.docx App H Reminder Email	IC Document

IC Title:

Agency IC Tracking Number:

0920-14AC

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-WORD			OMB_schools_AppendixD_Quest (2).docx		Yes	Yes	Fillable Printable
Other-Screenshots			OMB_schools_AppendixD2_Screen.docx		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: Occupational Health Epidemiological Studies and EEOICPA Records

FR Citation: 76 FR 16

Number of Respondents: 4,700

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	4,700	4,700
Annual IC Time Burden (Hours)	1,567	1,567
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
App A Authorizing Legislation	OMB_schools_AppendixA_Law.docx	04/14/2014
App B 60d FRN	OMB_schools_AppendixB_FRN.docx	04/14/2014
App C External Review Comments	OMB_schools_AppendixC_Review.docx	04/14/2014
App E IRB Approval Letter	OMB_schools_AppendixE_IRBLetter.docx	04/14/2014
App F Inviatational Email and Consent	OMB_schools_AppendixF__Invitation.docx	04/14/2014
App G Fact Sheet	OMB_schools_AppendixG.docx	04/14/2014
App H Reminder Email	OMB_schools_AppendixH_reminder.docx	04/14/2014

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