Teacher Questionnaire (Time 1)

School Health Profiles Test-Retest Reliability Study

Documents and Forms

Document Name Document Type
Teacher Questionnaire (Time 1) Form and Instruction
Lead Health Education Teacher Questionnaire AttD-Lead Health Edu Teacher Ques 4-1-20.docx Form and Instruction
Lead Health Education Teacher Questionnaire AttD-Lead Health Edu Teacher Ques 4-1-20.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Teacher Questionnaire (Time 1)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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 and Instruction	n/a	Lead Health Education Teacher Questionnaire	AttD-Lead Health Edu Teacher Ques 4-1-20.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	150	150
Annual IC Cost Burden (Dollars)	4,650	4,650

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.