Information Collection

School Associated Violent Deaths Surveillance System

IC 7069 under ICR 201001-0920-006 · OMB 0920-0604.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0604 can be found here:

Documents and Forms

Document Name Document Type
Attachment 6 Data Collection Instrument.doc Instruction
Attachment 10.Parental Consent Form.doc Instruction
Attachment 9.Telephone Consent Script.doc Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	School Associated Violent Deaths Surveillance System	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Instruction	Attachment 6 Data Collection Instrument.doc	Yes	Yes	Printable Only
Instruction	Attachment 10.Parental Consent Form.doc	Yes	Yes	Printable Only
Instruction	Attachment 9.Telephone Consent Script.doc	Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 35	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	Previously Approved
Annual Number of Responses for this IC	35	-35	70
Annual IC Time Burden (Hours)	35	-35	70
Annual IC Cost Burden (Dollars)	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.