Information Collection

Middle School Perspectives on Sexual Health Education in Fort Worth Independent School District

IC 225744 under ICR 201511-0920-001 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Middle School Focus Group Guide Middle School Perspectives on Sexual Health Education in Fort Worth Independent School District	Form and Instruction
Middle School Focus Group Guide Att 3-Middle School Focus Group Guide.docx	Form and Instruction
Att 1-PHS Act Legislation.pdf Authorizing Legislation: Public Health Service Act	IC Document
Att 2-60 Day FRN.pdf 60-day FRN for the generic 0920-0840 clearance	IC Document
Att 4-Consultants_on_the_IC.docx Consultants on the FWISD Information Collection	IC Document
Att 5-Documentation of IRB Approval.pdf IRB Approval	IC Document
Att 6-Parental Consent Form.docx Parental Consent Form	IC Document
Att 7-Student Verbal Assent Language.docx Student Verbal Assent	IC Document
Att 8-Description of Changes.docx Changes since Spring 2016 Information Collection	IC Document
Att 9-NonDisclosure Agreement.pdf FWISD Non-disclosure Agreement	IC Document
SSA-2017-02-16.docx Supporting Statement Part A	IC Document
SSB-2017-02-15.docx Supporting Statement Part B	IC Document

IC Title:

Middle School Perspectives on Sexual Health Education in Fort Worth Independent School District

Agency IC Tracking Number:

0920-17TK

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A				No		Paper Only

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 48

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	48	48
Annual IC Time Burden (Hours)	72	72
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation: Public Health Service Act		02/16/2017
60-day FRN for the generic 0920-0840 clearance		02/16/2017
Consultants on the FWISD Information Collection		02/16/2017
IRB Approval		02/16/2017
Parental Consent Form		02/16/2017
Student Verbal Assent		02/16/2017
Changes since Spring 2016 Information Collection		02/16/2017
FWISD Non-disclosure Agreement		02/16/2017
Supporting Statement Part A		02/16/2017
Supporting Statement Part B		02/16/2017

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

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