Information Collection

Broward County School Health Climate and Service Assessment Survey

IC 213072 under ICR 201409-0920-007 · OMB 0920-1048.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.