Att D_ Law Enforcement Officials (Interview)

School Associated Violent Deaths Surveillance System

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:

Documents and Forms

Document Name Document Type
Att D_Law Enforcement Interview Instrument.docx Other-CATI
Att F_Law Enforcement Participation Letter.docx Att F_Law Enforcement Paricipation Request Letter IC Document

Information Collection (IC) Details

IC Title:	Att D_ Law Enforcement Officials (Interview)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation: 42 CFR 242

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-CATI			Att D_Law Enforcement Interview Instrument.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Immunization Management

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	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	Previously Approved
Annual Number of Responses for this IC	35	0	35
Annual IC Time Burden (Hours)	38	3	35
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Att F_Law Enforcement Paricipation Request Letter	Att F_Law Enforcement Participation Letter.docx	01/12/2016

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