District Mental Health and Social Services

School Health Policies and Practices Study 2012

Documents and Forms

Document Name Document Type
Appendix G-15 Mental Health and Social Services District.doc Other-WORD
Appendix I-5 District Content Outlines.doc Appendix I-5 District Content Outlines IC Document
Appendix E-3 District Participant Notification Document.docx Appendix E-3 District Participant Notification Document IC Document

Information Collection (IC) Details

IC Title:	District Mental Health and Social Services	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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
Other-WORD			Appendix G-15 Mental Health and Social Services District.doc		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 685	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 95 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	685	685
Annual IC Time Burden (Hours)	343	343
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Appendix I-5 District Content Outlines	Appendix I-5 District Content Outlines.doc	06/24/2013
Appendix E-3 District Participant Notification Document	Appendix E-3 District Participant Notification Document.docx	06/24/2013

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