Information Collection

Healthy Students Questionnaire

IC 270338 under ICR 202408-0920-014 · OMB 0920-1455.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1455 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-24BJ Healthy Students Questionnaire	Form
0920-24BJ Healthy Student Questionnaire Attachment 11 - Healthy Student Questionnaire (final) 6.14.24.docx	Form
0920-24BJ Healthy Student Questionnaire Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx	Form

IC Title:

Healthy Students Questionnaire

Agency IC Tracking Number:

0920-24BJ

Is this a Common Form? No

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	0920-24BJ	Healthy Student Questionnaire	Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 13,150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,150	13,150
Annual IC Time Burden (Hours)	6,575	6,575
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.