Information Collection

DASH DEMO: Understanding Consortia Model Structures for Implementation of Health Programming in Schools

IC 245393 under ICR 201808-0920-023 · OMB 0920-0840.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0840 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-20CL Implementation of Health Programming in Schools Web Survey DASH DEMO: Understanding Consortia Model Structures for Implementation of Health Programming in Schools	Form and Instruction
Form 0920-21CL Consortia Staff Qualitative Discussion Guide and Consent - 90 Min Consortia District Level Interview DASH DEMO: Understanding Consortia Model Structures for Implementation of Health Programming in Schools	Form and Instruction
Form 0920-21CL Consortia Staff Qualitative Discussion Guide and Consent - 90 Min Consortia School Administrators DASH DEMO: Understanding Consortia Model Structures for Implementation of Health Programming in Schools	Form
0920-20CL Implementation of Health Programming in Schools Web Surv Att 2_20 Min Survey.docx	Form and Instruction
0920-21CL Consortia Staff Qualitative Discussion Guide and Consent Att 8_Verbal Consent Statement_90 min Interviews.docx	Form and Instruction
0920-21CL Consortia Staff Qualitative Discussion Guide and Consent Att 8_Verbal Consent Statement_90 min Interviews.docx	Form
Att 1_Auth Legislation.docx Authorizing Legislation	IC Document
SSA-consortia_1_15_2021.docx SSA	IC Document
SSB-consortia.docx SSB	IC Document
Att 9_IRB Approval.docx Att 9_IRB Approval	IC Document
Att 14_Consultants.docx Att 14_Consultants	IC Document
Att 13_60 Day FRN.pdf 60 Day FRN	IC Document
Att 12_Respondent Universe.docx Att 12_Respondent Universe	IC Document
Att 2a_Survey screenshots.pdf Att 2a_Survey screenshots	IC Document
Att 3_Consortia Staff Qualitative Discussion Guide.docx Att 3_Consortia Staff Qualitative Discussion Guide	IC Document
Att 5_ Survey Inviation Letter.docx Att 5_ Survey Invitation Letter	IC Document
Att 6_Consortia_District_ StakeholderIdentification.docx Att 6_Consortia_District_ StakeholderIdentification	IC Document
Att 9_IRB Approval.docx IRB Approval	IC Document
Att 10_Invitation Letter for Interviews.docx Att 10_Invitation Letter for Interviews	IC Document
Att 12_Respondent Universe.docx Att 12_Respondent Universe	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

DASH DEMO: Understanding Consortia Model Structures for Implementation of Health Programming in Schools

Agency IC Tracking Number:

0920-21CL

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-20CL	Yes	Yes	Fillable Fileable
Form and Instruction	0920-21CL	No		Fillable Fileable
Form	0920-21CL	No		Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 521

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

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	521	521
Annual IC Time Burden (Hours)	286	286
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Authorizing Legislation		01/27/2021
SSA		01/27/2021
SSB		01/27/2021
Att 9_IRB Approval		01/27/2021
Att 14_Consultants		01/27/2021
60 Day FRN		01/27/2021
Att 12_Respondent Universe		01/27/2021
Att 2a_Survey screenshots		01/29/2021
Att 3_Consortia Staff Qualitative Discussion Guide		01/29/2021
Att 5_ Survey Invitation Letter		01/29/2021
Att 6_Consortia_District_ StakeholderIdentification		01/29/2021
IRB Approval		01/29/2021
Att 10_Invitation Letter for Interviews		01/29/2021
Att 12_Respondent Universe		01/29/2021

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

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