GenIC UNICEF/Washington Group School Environment Evaluation Study 2016

NCHS Questionnaire Design Research Laboratory

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0222 can be found here:

Documents and Forms

Document Name Document Type
Attachment 1 Questionnaire.docx Other-WORD
Attachment 2 Phone Screener.docx Other-WORD
UNICEF 10-day letter 011216.docx UNICEF/WGSEnviornment Evaluation Study IC Document

Information Collection (IC) Details

IC Title:	GenIC UNICEF/Washington Group School Environment Evaluation Study 2016	Agency IC Tracking Number:	16JZ

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			Attachment 1 Questionnaire.docx		Yes	Yes	Fillable Fileable
Other-WORD			Attachment 2 Phone Screener.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 26	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	26	26
Annual IC Time Burden (Hours)	18	18
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
UNICEF/WGSEnviornment Evaluation Study	UNICEF 10-day letter 011216.docx	02/08/2016

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