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Los Angeles Unified School District School Health Climate and Service Assessment Survey
Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services
OMB: 0920-1048
IC ID: 213073
OMB.report
HHS/CDC
OMB 0920-1048
ICR 201409-0920-007
IC 213073
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1048 can be found here:
2018-02-20 - Revision of a currently approved collection
Documents and Forms
Document Name
Document Type
Los Angeles Unified School District School Health Climate and Service Assessment Survey
Form
Los Angeles Unified School District School Helath Climat
Att 7-Screens_LA.docx
Form
Att 16-Consent_LA.docx
Los Angeles Unified Schools Informed Consent
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Los Angeles Unified School District School Health Climate and Service Assessment Survey
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
Form
None
Los Angeles Unified School District School Helath Climate and Service Assessment Survey
Att 7-Screens_LA.docx
None
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
163
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
163
0
163
0
0
0
Annual IC Time Burden (Hours)
68
0
68
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Los Angeles Unified Schools Informed Consent
Att 16-Consent_LA.docx
09/10/2014
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.