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Broward County School Health Climate and Service Assessment Survey
Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services
OMB: 0920-1048
IC ID: 213072
OMB.report
HHS/CDC
OMB 0920-1048
ICR 201801-0920-007
IC 213072
( )
Documents and Forms
Document Name
Document Type
Broward County School Health Climate and Service Assessment Survey
Form
Broward County School Assessment
Att 6-Screens_BrowardCounty.docx
Form
Att 3-DataCollect_BrowardCounty.docx
Broward County Assessment - word
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Broward County School Health Climate and Service Assessment Survey
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
Modified
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
Form
none
Broward County School Assessment
Att 6-Screens_BrowardCounty.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
245
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 New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
245
0
82
0
0
163
Annual IC Time Burden (Hours)
102
0
34
0
0
68
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Broward County Assessment - word
Att 3-DataCollect_BrowardCounty.docx
01/29/2018
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.