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Student Component - Household Study Form A
Information Collection on Cause-Specific Absenteeism in Schools
OMB: 0920-1039
IC ID: 228816
OMB.report
HHS/CDC
OMB 0920-1039
ICR 202108-0920-002
IC 228816
( )
Documents and Forms
Document Name
Document Type
Form 0920-1039
Student Component - Household Study Form A
Form
0920-1039 ORCHARDS HOUSEHOLD STUDY FORM A
Att C4a household forms all.pdf
Form
0920-1039 ORCHARDS HOUSEHOLD STUDY FORM A
Att C4a household forms all.pdf
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Student Component - Household Study Form A
Agency IC Tracking Number:
0920-1039
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
0920-1039
ORCHARDS HOUSEHOLD STUDY FORM A
Att C4a household forms all.pdf
NA
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
Records of Subjects in Health Promotion and Education Studies
FR Citation:
51 FR 42484
Number of Respondents:
300
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
300
0
0
0
300
0
Annual IC Time Burden (Hours)
25
0
0
0
25
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
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.
