Information Collection

School Health Queationnaire

IC 213407 under ICR 201502-0920-014 · OMB 0920-1047.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
School Health Queationnaire	Form and Instruction
School Health Questionnaire Appendix D change request.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	None	School Health Questionnaire	Appendix D change request.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records

Title: 09-20-0147, Occupational Health Epidemiological Studies and EEOICPA Program Records

FR Citation: 76 FR 34706

Number of Respondents: 3,200

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Previously Approved
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	1,067	1,067
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.