OMB control number

[NCCDPHP] Healthy Schools Program Evaluation

OMB 0920-1455 ยท HHS/CDC.

OMB 0920-1455

The proposed project aims to evaluate processes and outcomes of the programs of 20 state entities funded by CDC's Division of Adolescent and School Health to improve health, academic achievement, and well-being of students in K-12 schools nationwide. CDC awarded funds through cooperative agreement DP23-0002 (2302 Program) to 20 funding recipients (states, universities, and a tribal nation) to improve health, academic achievement, and well-being of students in K-12 schools. A portion of the funding within each state is allocated to one priority local education agency (LEA) and its corresponding schools to support the implementation of policies, practices, and programs to increase physical activity, healthy dietary behaviors, and management of chronic health conditions among students. CDC is conducting a mixed-methods multi-level evaluation of the 2302 Program and associated outcomes. Evaluation findings will allow CDC to help recipients improve their programs as they progress over the five-year funding period. This change request is to follow recent executive orders.

The latest form for [NCCDPHP] Healthy Schools Program Evaluation expires 2028-01-31 and is listed under ICR 202504-0920-011.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-24BJ Healthy Student QuestionnaireForm
Form 0920-24BJ Healthy Students QuestionnaireForm
Form 0920-24BJ Healthy Schools QuestionnaireForm
Form 0920-24BJ Healthy Schools QuestionnaireForm
Form 0920-24BJ Interview Guide Priority LEAForm
Form 0920-24BJ LEA InterviewsForm
Form 0920-24BJ Interview Guide RecipientForm
Form 0920-24BJ Recipient InterviewsForm
Form 0920-24BJ Monthly Reporting FormForm
Form 0920-24BJ Monthly ReportingForm
Change Request Memo - DASH DP-23-0002 (Clean) 2025.05.02 V4.1.docxJustification for No Material/Nonsubstantive Change
Change Request Memo - DASH DP-23-0002 (Clean) 2025.05.02 V4.1.docx Justification for No Material/Nonsubstantive Change
Attachment 12 - Screenshots of Healthy Student Questionnaire_updated w Race Ethnicity Q 10.31.24 (1) (002).docxSupplementary Document
Attachment 12 - Screenshots of Healthy Student Questionnaire_updated w Race Ethnicity Q 10.31.24 (1) (002).docx Supplementary Document
Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docxSupplementary Document
Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx Supplementary Document
FRN 30 Day Text - 2302 Healthy Schools Evaluation (003).docxSupplementary Document
FRN 30 Day Text - 2302 Healthy Schools Evaluation (003).docx Supplementary Document
Attachment 20 - 2302 Healthy Schools IRB determination letter 06-05-24.pdfSupplementary Document
Attachment 20 - 2302 Healthy Schools IRB determination letter 06-05-24.pdf Supplementary Document
Attachment 19 - Healthy Student Questionnaire Student Assent Form (final) 6.14.24.docxSupplementary Document
Attachment 19 - Healthy Student Questionnaire Student Assent Form (final) 6.14.24.docx Supplementary Document
Attachment 18 - Healthy Student Questionnaire 18+ Consent Form (final) 6.14.24.docxSupplementary Document
Attachment 16 - Healthy Schools Questionnaire Consent Form (final) 6.14.24.docxSupplementary Document
Attachment 16 - Healthy Schools Questionnaire Consent Form (final) 6.14.24.docx Supplementary Document
Attachment 17 - Healthy Students Questionnaire Parent Consent Forms.docxSupplementary Document
Attachment 17 - Healthy Students Questionnaire Parent Consent Forms.docx Supplementary Document
Attachment 15 - Interview Consent Forms.docxSupplementary Document
Attachment 15 - Interview Consent Forms.docx Supplementary Document
Attachment 13 - Published 60 day FRN Healthy Schools.pdfSupplementary Document
Attachment 13 - Published 60 day FRN Healthy Schools.pdf Supplementary Document
Attachment 10 - Screenshots of Healthy Schools Questionnaire (final) 6.14.24.docxSupplementary Document
Attachment 10 - Screenshots of Healthy Schools Questionnaire (final) 6.14.24.docx Supplementary Document
Attachment 12 - Screenshots of Healthy Student Questionnaire (final) 6.14.24.docxSupplementary Document
Attachment 12 - Screenshots of Healthy Student Questionnaire (final) 6.14.24.docx Supplementary Document
Attachment 08 - Interview Invitation Email.docxSupplementary Document
Attachment 08 - Interview Invitation Email.docx Supplementary Document
Attachment 05 - Monthly Indicator Report Qualtrics Screenshots (EO revised) 2025.05.02.docxSupplementary Document
Attachment 05 - Monthly Indicator Report Qualtrics Screenshots (EO revised) 2025.05.02.docx Supplementary Document
Attachment 04 - Monthly Reporting Form Email Notification.docxSupplementary Document
Attachment 04 - Monthly Reporting Form Email Notification.docx Supplementary Document
Attachment 02 - Authorizing Legislation - Evidence-Based Policymaking Act 2018.pdfSupplementary Document
Attachment 02 - Authorizing Legislation - Evidence-Based Policymaking Act 2018.pdf Supplementary Document
Attachment 01 - Authorizing Legislation - Public Health Service Act.pdfSupplementary Document
Attachment 01 - Authorizing Legislation - Public Health Service Act.pdf Supplementary Document
Healthy Schools - SSB.docxSupporting Statement B
Healthy Schools - SSA (EO revised, clean) 2025.04.21.docxSupporting Statement A
Healthy Schools - SSA (EO revised, clean) 2025.04.21.docxSupporting Statement A
Healthy Students Questionnaire Form
Healthy Students Questionnaire Form
Healthy Schools Questionnaire Form
Healthy Schools Questionnaire Form
LEA Interviews Form
LEA Interviews Form
Recipient Interviews Form
Recipient Interviews Form
Monthly Reporting Form
Monthly Reporting Form

All Historical Document Collections

Historical document collections
ReferenceFilingReceivedConcludedAction
202504-0920-011 No material or nonsubstantive change to a currently approved collection 2025-05-15
202408-0920-014 New collection (Request for a new OMB Control Number) 2024-08-22 Approved with change

OMB Details

Monthly Reporting

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
FormNameElectronic accessType
Form 0920-24BJMonthly Reporting FormFillable FileableForm

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.