Information Collection

Los Angeles Unified School District School Health Climate and Service Assessment Survey

IC 213073 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⚠️ Notice: This information collection may be referencing outdated material.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
Los Angeles Unified School District School Health Climate and Service Assessment Survey	Form
Los Angeles Unified School District School Helath Climat Att 7-Screens_LA.docx	Form
Att 16-Consent_LA.docx Los Angeles Unified Schools Informed Consent	IC Document

IC Title:

Los Angeles Unified School District 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	Los Angeles Unified School District School Helath Climate and Service Assessment Survey	Att 7-Screens_LA.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: Individuals or Households

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
Los Angeles Unified Schools Informed Consent	Att 16-Consent_LA.docx	09/10/2014

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