Funded District Questionnaire

Promoting Adolescent Health through School-Based HIV Prevention

Documents and Forms

Document Name Document Type
Funded District Questionnaire Form and Instruction
PERS: Funded District Questionnaire Att3_Funded District Qnr Items.docx Form and Instruction
PERS: Funded District Questionnaire Att3_Funded District Qnr Items.docx Form and Instruction
Att8a-Funded District Scrn Shot.docx Example screenshots (PERS: Funded District Questionnaire) IC Document
Att8a-Funded District Scrn Shot.docx Example screenshots (PERS: Funded District Questionnaire) IC Document

Information Collection (IC) Details

IC Title:	Funded District Questionnaire	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	None	PERS: Funded District Questionnaire	Att3_Funded District Qnr Items.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 25	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	100	100
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Example screenshots (PERS: Funded District Questionnaire)	Att8a-Funded District Scrn Shot.docx	09/23/2022

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