Information Collection

Los Angeles Unified School District School Health Climate and Service Assessment Survey

IC 213073 under ICR 201801-0920-007 · OMB 0920-1048.

Documents and Forms

Document Name Document Type
Los Angeles Unified School District School Health Climate and Service Assessment Survey Form
Los Angeles Schools Assessment Att 7-Screens_LA.docx Form
Att 4-DataCollect_LA.docx LA School Assessment - Word IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Los Angeles Unified School District School Health Climate and Service Assessment Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	none	Los Angeles Schools Assessment	Att 7-Screens_LA.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 245	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	245	82	163
Annual IC Time Burden (Hours)	102	34	68
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
LA School Assessment - Word	Att 4-DataCollect_LA.docx	01/29/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.