Broward County School Health Climate and Service Assessment Survey

Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1048 can be found here:

Documents and Forms

Document Name Document Type
Broward County School Health Climate and Service Assessment Survey Form
Broward County Public Schools School Health Climate and Att 6-Screens_BrowardCounty.docx Form
Att 15-Consent_Broward County.docx Broward County Survey Informed Consent IC Document

Information Collection (IC) Details

IC Title:	Broward County School Health Climate and Service Assessment Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Form	None	Broward County Public Schools School Health Climate and Service Assessment	Att 6-Screens_BrowardCounty.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 163	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	163	163
Annual IC Time Burden (Hours)	68	68
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Broward County Survey Informed Consent	Att 15-Consent_Broward County.docx	09/10/2014

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