School Absentee Reporting Form

Information Collection on Cause-Specific Absenteeism in Schools (Pittsburgh Location)

Documents and Forms

Document Name Document Type
School Absentee Reporting Form Form
Absentee Reporting Form - Survey of Parent or Child 24MA Attachment H Absentee Reporting Form_Survey of Parent or Child.pdf Form

Information Collection (IC) Details

IC Title:	School Absentee Reporting Form	Agency IC Tracking Number:

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
Form	None	Absentee Reporting Form - Survey of Parent or Child 24MAR2015	Attachment H Absentee Reporting Form_Survey of Parent or Child.pdf	None	No		Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160, Records of Subjects in Health Promotion and Eductaion Studies	FR Citation: 51 FR 42484

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	833	833
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.