Information Collection

Customer Satisfaction Survey for Healthier School Environments Workshops

IC 246196 under ICR 202012-2010-001 · OMB 2010-0042.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5800-040 Customer Satisfaction Survey for Healthier School Environments Workshops	Form
5800-040 HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFAC 2434ss60 Healthier Survey_ 2021.docx	Form
5800-040 HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFAC 2434ss60 Healthier Survey_ 2021.docx	Form
2434ss60 Healthier Survey Justification Revised 2021.docx Justification	IC Document
2434ss60 Healthier Survey Justification Revised 2021.docx Justification	IC Document

IC Title:

Agency IC Tracking Number:

2434.132

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
Form	5800-040	HEALTHIER SCHOOL ENVIRONMENTS WORKSHOP CUSTOMER SATISFACTION SURVEY	2434ss60 Healthier Survey_ 2021.docx		Yes	Yes	Fillable Fileable

Line of Business: Environmental Management

Subfunction: Pollution Prevention and Control

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,250

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,250	1,250
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Justification	2434ss60 Healthier Survey Justification Revised 2021.docx	03/11/2021

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