Information Collection

Bioispecimen Collection from Students (Absentee Surveillance)

IC 214475 under ICR 201412-0920-016 · OMB 0920-1056.

Documents and Forms

Document Name Document Type
Bioispecimen Collection from Students (Absentee Surveillance) Form and Instruction
Oral Script to obtain Assent from Children 5-6 (after re Attachment F1a Oral Script to Obtain Assent from 5-6 Years Old_After Return from Absence.pdf Form and Instruction
Oral Script to obtain assent from Children 5-6 (in the N Attachment F1b Oral Script to Obtain Assent from 5 to 6 year olds_Nurse Office.pdf Form and Instruction
Oral Script to obtain assent from Children 7-12 (after r Attachment F2a Oral Script to Obtain Assent from 7 to 12 year olds_After return from absence.pdf Form and Instruction
Oral Script to obtain assent from Children 7-12 (in the Attachment F2b Oral Script to Obtain Assent from 7 to 12 year olds_Nurse Office.pdf Form and Instruction
Oral Script to obtain assent from Children 13 plus (afte Attachment F3a Oral Script to Obtain Assent from 13 plus year olds_After return from absence.pdf Form and Instruction
Oral Script to obtain assent from Children 13 plus (in t Attachment F3b Oral Script to Obtain Assent from 13 plus year olds_Nurse Office.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Bioispecimen Collection from Students (Absentee Surveillance)	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?	Electronic Capability
Form and Instruction	None	Oral Script to obtain Assent from Children 5-6 (after return to school from absence)	Attachment F1a Oral Script to Obtain Assent from 5-6 Years Old_After Return from Absence.pdf	None	No	Paper Only
Form and Instruction	None	Oral Script to obtain assent from Children 5-6 (in the Nurse's office)	Attachment F1b Oral Script to Obtain Assent from 5 to 6 year olds_Nurse Office.pdf	None	No	Paper Only
Form and Instruction	None	Oral Script to obtain assent from Children 7-12 (after return to school from absence)	Attachment F2a Oral Script to Obtain Assent from 7 to 12 year olds_After return from absence.pdf	None	No	Paper Only
Form and Instruction	None	Oral Script to obtain assent from Children 7-12 (in the Nurse's office)	Attachment F2b Oral Script to Obtain Assent from 7 to 12 year olds_Nurse Office.pdf	None	No	Paper Only
Form and Instruction	None	Oral Script to obtain assent from Children 13 plus (after return to school from absence)	Attachment F3a Oral Script to Obtain Assent from 13 plus year olds_After return from absence.pdf	None	No	Paper Only
Form and Instruction	None	Oral Script to obtain assent from Children 13 plus (in the Nurse's office)	Attachment F3b Oral Script to Obtain Assent from 13 plus year olds_Nurse Office.pdf	None	No	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: 09-20-0160, Records of Subjects in Health Promotion and Eductaion Studie	FR Citation: 51 FR 42484

Number of Respondents: 2,500	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	10,000	10,000
Annual IC Time Burden (Hours)	833	833
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.