State Education Agency Sexual Health Services Measures

Promoting Adolescent Health through School-based HIV/STD Prevention

Documents and Forms

Document Name Document Type
State Education Agency Sexual Health Services Measures Form
SEA SHS Measures Att 4b SEA SHS Items.docx Form

Information Collection (IC) Details

IC Title:	State Education Agency Sexual Health Services 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 SHS Measures	Att 4b SEA SHS Items.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)	108	-6	114
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.