School Staff Interview

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⚠️ Notice: This information collection may be referencing outdated material.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
School Staff Interview Form
School Climate Index Interview Guide for School Staff Att 11-CIIG_School Staff.docx Form
Att 18-Consent School Climate Interviews.docx School Climate Interview Informed Consent IC Document

Information Collection (IC) Details

IC Title:	School Staff Interview	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	School Climate Index Interview Guide for School Staff	Att 11-CIIG_School Staff.docx	None	No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 19	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	19	19
Annual IC Time Burden (Hours)	29	29
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
School Climate Interview Informed Consent	Att 18-Consent School Climate Interviews.docx	09/10/2014

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