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Wave 1 - SEA Staff Web Survey
Evaluation of the DP18-1801 Healthy Schools Program
OMB: 0920-1302
IC ID: 238731
OMB.report
HHS/CDC
OMB 0920-1302
ICR 201910-0920-010
IC 238731
( )
Documents and Forms
Document Name
Document Type
Wave 1 - SEA Staff Web Survey
Form and Instruction
SEA Implementation Survey
Attachment 7 -SEA Web-Based Implementation Survey and Participant Consent.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Wave 1 - SEA Staff Web 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 and Instruction
NA
SEA Implementation Survey
Attachment 7 -SEA Web-Based Implementation Survey and Participant Consent.docx
NA
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:
3
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 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
3
0
3
0
0
0
Annual IC Time Burden (Hours)
4
0
4
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
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.