Information Collection

School Health Queationnaire

IC 213407 under ICR 201410-0920-004 · OMB 0920-1047.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1047 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
OMB_schools_AppendixD_Quest.docx	Other-WORD

IC Title:

School Health Queationnaire

Agency IC Tracking Number:

14AC

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
Other-WORD			OMB_schools_AppendixD_Quest.docx		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: 09-20-0147, Occupational Health Epidemiological Studies and EEOICPA Program Records

FR Citation: 76 FR 34706

Number of Respondents: 3,200

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	3,200	3,200
Annual IC Time Burden (Hours)	1,067	1,067
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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