Information Collection

School Level Survey

IC 213255 under ICR 201409-0930-002 · OMB 0930-0347.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form School Level Surve School Level Survey	Form and Instruction
School Level Surve School Level Survey Attachment H.1_School Level Survey_Implementation.docx	Form and Instruction
Attachment H.2_School Level Survey Recruitment Script.pdf School Level Survey Recruitment Script	IC Document

IC Title:

School Level 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 and Instruction	School Level Survey	School Level Survey	Attachment H.1_School Level Survey_Implementation.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,100

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	2,100	2,100
Annual IC Time Burden (Hours)	945	945
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
School Level Survey Recruitment Script	Attachment H.2_School Level Survey Recruitment Script.pdf	09/25/2014

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