District Collaborator Indicator Data Instrument

Mulit-Site Evaluation of the Safe Schools/Healthy Students (SS/HS) State Program

Documents and Forms

Document Name Document Type
Form District collabora District Collaborator Indicator Data Instrument Form and Instruction
District collabora District collaboration indicator data instrument Attachment F_District collaboration indicator data instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	District Collaborator Indicator Data Instrument	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 and Instruction	District collaboration indicator data instrument	District collaboration indicator data instrument	Attachment F_District collaboration indicator data instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 21	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	84	84
Annual IC Time Burden (Hours)	126	126
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.