Information Collection

DC Public Schools Student Perspectives on Access to Recommended Adolescent Preventive Health Services

IC 232663 under ICR 201808-0920-005 · OMB 0920-1235.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1235 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Att 3_Student Focus Group Guide.docx	Other-Focus Group Guide
SSA_DCPS_FG.docx Supoprting Statement A	IC Document
SSB_DCPS_FG.docx Supporting Statement B	IC Document
Att 4_IRB Approval Documentation.PDF IRB Approval	IC Document
Att 5_ Parental Consent Form.docx Parental Consent for Minor	IC Document
Att 6_ Adult Student Consent Form.docx Adult Student Consent	IC Document
Att 7_Youth Student Consent Form.docx Youth Student Consent	IC Document
Att 8_Student Verbal Assent.docx Student Verbal Assent	IC Document

IC Title:

DC Public Schools Student Perspectives on Access to Recommended Adolescent Preventive Health Services

Agency IC Tracking Number:

092-1235-18AVA

IC Status: New

Obligation to Respond: Voluntary

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
Other-Focus Group Guide			Att 3_Student Focus Group Guide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Supoprting Statement A	SSA_DCPS_FG.docx	08/13/2018
Supporting Statement B	SSB_DCPS_FG.docx	08/13/2018
IRB Approval	Att 4_IRB Approval Documentation.PDF	08/13/2018
Parental Consent for Minor	Att 5_ Parental Consent Form.docx	08/13/2018
Adult Student Consent	Att 6_ Adult Student Consent Form.docx	08/13/2018
Youth Student Consent	Att 7_Youth Student Consent Form.docx	08/13/2018
Student Verbal Assent	Att 8_Student Verbal Assent.docx	08/13/2018

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