Information Collection

State Education Agency Safe and Supportive Environment Measures

IC 212965 under ICR 201710-0920-008 · OMB 0920-1049.

Documents and Forms

Documents and forms in this information collection
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

IC Title:

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.