State Education Agency Safe and Supportive Environment Measures

Promoting Adolescent Health through School-based HIV/STD Prevention

Documents and Forms

Document Name Document Type
State Education Agency Safe and Supportive Environment Measures Form
SEA SSE Measures Att 4a SEA SSE Items.docx Form
SEA - Screenshots Att 8a SEA Screenshots.docx Form

Information Collection (IC) Details

IC Title:	State Education Agency Safe and Supportive Environment Measures	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	NA	SEA SSE Measures	Att 4a SEA SSE Items.docx	NA	Yes	Yes	Fillable Fileable
Form	NA	SEA - Screenshots	Att 8a SEA Screenshots.docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 18	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	36	-2	38
Annual IC Time Burden (Hours)	36	-2	38
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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