Local Education Agency Safe and Supportive Environment Measures

Promoting Adolescent Health through School-based HIV/STD Prevention

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1049 can be found here:

Documents and Forms

Document Name Document Type
Local Education Agency Safe and Supportive Environment Measures Form
Screenshots for Local Education Agencies Att 8b LEA Screens 5abc.docx Form
LEA Safe and Supportive Environment Measures Att 5a LEA SSE Items.docx Form

Information Collection (IC) Details

IC Title:	Local Education Agency Safe and Supportive Environment Measures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Screenshots for Local Education Agencies	Att 8b LEA Screens 5abc.docx		Yes	Yes	Fillable Fileable
Form	none	LEA Safe and Supportive Environment Measures	Att 5a LEA SSE Items.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	204	204
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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