Local Education Agency Safe and Supportive Environment Measures

Promoting Adolescent Health through School-based HIV/STD Prevention

Documents and Forms

Document Name Document Type
Local Education Agency Safe and Supportive Environment Measures Form
LEA SSE Measures Att 5a LEA SSE Items.docx Form
LEA - Screenshots Att 8b LEA Screenshots.docx Form

Information Collection (IC) Details

IC Title:	Local 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	LEA SSE Measures	Att 5a LEA SSE Items.docx	NA	Yes	Yes	Fillable Fileable
Form	NA	LEA - Screenshots	Att 8b LEA 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: 17	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	34	34
Annual IC Time Burden (Hours)	204	204
Annual IC Cost Burden (Dollars)	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.