Information Collection Request

[NCCDPHP] Healthy Schools Program Evaluation

ICR 202408-0920-014 · OMB 0920-1455 · Received in OIRA

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-24BJ Healthy Students Questionnaire Form New Repair queued
Form 0920-24BJ Healthy Schools Questionnaire Form New Repair queued
Form 0920-24BJ LEA Interviews Form New Repair queued
Form 0920-24BJ Recipient Interviews Form New Repair queued
Form 0920-24BJ Monthly Reporting Form New Repair queued
FRN 30 Day Text - 2302 Healthy Schools Evaluation (003).docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 20 - 2302 Healthy Schools IRB determination letter 06-05-24.pdf Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 19 - Healthy Student Questionnaire Student Assent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 18 - Healthy Student Questionnaire 18+ Consent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 16 - Healthy Schools Questionnaire Consent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Available
Attachment 17 - Healthy Students Questionnaire Parent Consent Forms.docx Supplementary Document Uploaded 2024-08-22 Missing upstream
Attachment 15 - Interview Consent Forms.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 13 - Published 60 day FRN Healthy Schools.pdf Supplementary Document Uploaded 2024-08-22 Available
Attachment 10 - Screenshots of Healthy Schools Questionnaire (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 12 - Screenshots of Healthy Student Questionnaire (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 08 - Interview Invitation Email.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 05 - Monthly Indicator Report Qualtrics Screenshots (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 04 - Monthly Reporting Form Email Notification.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 02 - Authorizing Legislation - Evidence-Based Policymaking Act 2018.pdf Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 01 - Authorizing Legislation - Public Health Service Act.pdf Supplementary Document Uploaded 2024-08-22 Repair queued
Healthy Schools - SSB.docx Supporting Statement B Uploaded 2024-08-22 Repair queued
Healthy Schools - SSA.docx Supporting Statement A Uploaded 2024-08-22 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
270338 Healthy Students Questionnaire Form New
270336 Healthy Schools Questionnaire Form New
270335 LEA Interviews Form New
270334 Recipient Interviews Form New
270318 Monthly Reporting Form New

ICR Details

Reginfo record details
table that charts list comparision
  Requested Previously Approved
36 Months From Approved
13,720 0
6,900 0
0 0





Reginfo record details
5
table that charts list of burden
IC Title Form No. Form Name
Healthy Schools Questionnaire 0920-24BJ Healthy Schools Questionnaire
Healthy Students Questionnaire 0920-24BJ Healthy Student Questionnaire
LEA Interviews 0920-24BJ Interview Guide Priority LEA
Monthly Reporting 0920-24BJ Monthly Reporting Form
Recipient Interviews 0920-24BJ Interview Guide Recipient

table that charts list of burden
  Total Request Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 13,720 0 0 13,720 0 0
Annual Time Burden (Hours) 6,900 0 0 6,900 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No