School Health Resources Assessment: Awareness, Satisfaction, and Utility

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Att. A - Asessment Instrument Word Version.docx Other-WORD
Att. B Assessment Instrument Web Version.docx Other-Web Version
Att. C List of School Health Coordinators.docx Att C_ List of SCHOOL Health Coordinators IC Document
Att. D Notification Email.docx Att D_Notification Email IC Document
Att. E - Reminder Email (Week 2).docx Att E_ Reminder E-mail Week 2 IC Document
Att. F - Reminder Email (Week 3).docx Att F_Second Reminder Email Week 3 IC Document
SCH-TOOL-SSA.docx Supporting Statement A IC Document
SCH-TOOL-SSB.docx Supporting Statement B IC Document

Information Collection (IC) Details

IC Title:	School Health Resources Assessment: Awareness, Satisfaction, and Utility	Agency IC Tracking Number:	15AIF

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			Att. A - Asessment Instrument Word Version.docx		Yes	Yes	Fillable Printable
Other-Web Version			Att. B Assessment Instrument Web Version.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	16	16
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att C_ List of SCHOOL Health Coordinators	Att. C List of School Health Coordinators.docx	05/11/2015
Att D_Notification Email	Att. D Notification Email.docx	05/11/2015
Att E_ Reminder E-mail Week 2	Att. E - Reminder Email (Week 2).docx	05/11/2015
Att F_Second Reminder Email Week 3	Att. F - Reminder Email (Week 3).docx	05/11/2015
Supporting Statement A	SCH-TOOL-SSA.docx	05/11/2015
Supporting Statement B	SCH-TOOL-SSB.docx	05/11/2015

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