School Health Queationnaire

Application of a Web-based health Survey In Schools

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1047 can be found here:

Documents and Forms

Document Name Document Type
OMB_schools_AppendixD_Quest.docx Other-WORD

Information Collection (IC) Details

IC Title:	School Health Queationnaire	Agency IC Tracking Number:	14AC

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			OMB_schools_AppendixD_Quest.docx		Yes	Yes	Fillable Printable

Line of Business: Education

Subfunction: Elementary, Secondary, and Vocational Education

Privacy Act System of Records
Title: 09-20-0147, Occupational Health Epidemiological Studies and EEOICPA Program Records	FR Citation: 76 FR 34706

Number of Respondents: 3,200	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,200	3,200
Annual IC Time Burden (Hours)	1,067	1,067
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.