Information Collection

Att H1_Data Collection Checklist

IC 225827 under ICR 201708-0920-020 · OMB 0920-1205.

Documents and Forms

Document Name Document Type
Att H1_Data Collection Checklist for the NYTS Pilot (Revised 1.12.2017) v2 (OSH).docx Other-WORD
Att H2_Letter to Teachers in Participating Schools.docx Att H2_Letters to Teachers IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Att H1_Data Collection Checklist	Agency IC Tracking Number:	16AWN

Is this a Common Form? No		IC Status: Unchanged

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			Att H1_Data Collection Checklist for the NYTS Pilot (Revised 1.12.2017) v2 (OSH).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 292	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	292	292
Annual IC Time Burden (Hours)	73	73
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att H2_Letters to Teachers	Att H2_Letter to Teachers in Participating Schools.docx	03/01/2017

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