Information Collection

Application of a Web-Based Health Survey Tool in Schools

IC 213408 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⚠️ Notice: This information collection may be referencing outdated material.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

Document Name Document Type
OMB_schools_AppendixE_Nonresponder_quest.docx Other-WORD

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Application of a Web-Based Health Survey Tool in Schools	Agency IC Tracking Number:	14AC

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
Other-WORD			OMB_schools_AppendixE_Nonresponder_quest.docx		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.