Information Collection

Youth Health and Climate School Survey

IC 212672 under ICR 201707-0920-003 · OMB 0920-1035.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Youth Health and Climate School Survey	Form
Youth Health and School Climate Survey Att 3a REVISED Youth Health_School Climate Questionnaire.docx	Form
Att 3 Youth Health and School Climate Questionnaire.docx Previous Survey	IC Document

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	none	Youth Health and School Climate Survey	Att 3a REVISED Youth Health_School Climate Questionnaire.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 16,500

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	Previously Approved
Annual Number of Responses for this IC	16,500	5,500	11,000
Annual IC Time Burden (Hours)	11,000	3,667	7,333
Annual IC Cost Burden (Dollars)	46,695	46,695	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Previous Survey	Att 3 Youth Health and School Climate Questionnaire.docx	07/10/2017

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