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⚠️ Notice: This information collection may be referencing outdated material.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

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:

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 %

	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

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.