Information Collection

School Health Resources: Assessing Awareness, Satisfaction, and Utility

IC 223213 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
School Health Resources: Assessing Awareness, Satisfaction, and Utility	Form and Instruction
Web-based Assessment Instrument Attachment B - Web-based Assessment Instrument_Web Version.pdf	Form and Instruction
State Level Phone Interview Guide Attachment C - State Level Phone Interview Guide.docx	Form and Instruction
District Level In-Person Interview Guide Attachment D - District Level In-Person Interview Guide.docx	Form and Instruction
TOOLS-SCH-SSA.docx Supporting Statement A	IC Document
TOOLS-SCH-SSB.docx Supporting Statement B	IC Document
Attachment A - Web-based Assessment Instrument_Word Version.docx Assessment Instrument (Word version)	IC Document
Attachment E - Logic Model.pptx Logic Model	IC Document
Attachment F - Web-based Assessment Invitation Email.docx Invitation Email for Web-based Assessment	IC Document
Attachment G - Web-based Assessment Reminder Email 1.docx Reminder Email 1 for Web-based Assessment	IC Document
Attachment H - Web-based Assessment Reminder Email 2.docx Reminder Email 2 for Web-based Assessment	IC Document
Attachment I - State Level Phone Interview Invitation Email.docx Invitation Email for State Level Phone Interview	IC Document
Attachment J - State Level Phone Interview Reminder Email.docx Reminder Email for State Level Phone Interview	IC Document
Attachment K - State Level Phone Interview Reminder Phone Script.docx Reminder Phone Script for State Level Phone Interview	IC Document
Attachment L - One-Page Fact Sheet about the Project.docx Fact Sheet About the Project	IC Document
Attachment M - District Level In-Person Interview Notification Email.docx Notification Email for District Level In-Person Interview	IC Document
Attachment N - District Level In-Person Interview Reminder Email.docx Reminder Email for District Level In-Person Interview	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

School Health Resources: Assessing Awareness, Satisfaction, and Utility

Agency IC Tracking Number:

0920-16BBP

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	State Level Phone Interview Guide	Attachment C - State Level Phone Interview Guide.docx	No		Paper Only
Form and Instruction	N/A	Web-based Assessment Instrument	Attachment B - Web-based Assessment Instrument_Web Version.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	N/A	District Level In-Person Interview Guide	Attachment D - District Level In-Person Interview Guide.docx	No		Paper Only

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 127

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	127	127
Annual IC Time Burden (Hours)	77	77
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supporting Statement A	TOOLS-SCH-SSA.docx	08/26/2016
Supporting Statement B	TOOLS-SCH-SSB.docx	08/26/2016
Assessment Instrument (Word version)	Attachment A - Web-based Assessment Instrument_Word Version.docx	08/26/2016
Logic Model	Attachment E - Logic Model.pptx	08/26/2016
Invitation Email for Web-based Assessment	Attachment F - Web-based Assessment Invitation Email.docx	08/26/2016
Reminder Email 1 for Web-based Assessment	Attachment G - Web-based Assessment Reminder Email 1.docx	08/26/2016
Reminder Email 2 for Web-based Assessment	Attachment H - Web-based Assessment Reminder Email 2.docx	08/26/2016
Invitation Email for State Level Phone Interview	Attachment I - State Level Phone Interview Invitation Email.docx	08/26/2016
Reminder Email for State Level Phone Interview	Attachment J - State Level Phone Interview Reminder Email.docx	08/26/2016
Reminder Phone Script for State Level Phone Interview	Attachment K - State Level Phone Interview Reminder Phone Script.docx	08/26/2016
Fact Sheet About the Project	Attachment L - One-Page Fact Sheet about the Project.docx	08/26/2016
Notification Email for District Level In-Person Interview	Attachment M - District Level In-Person Interview Notification Email.docx	08/26/2016
Reminder Email for District Level In-Person Interview	Attachment N - District Level In-Person Interview Reminder Email.docx	08/26/2016

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