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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
DASH DEMO: Understanding Consortia Model Structures for Implementation of Health Programming in Schools
Agency IC Tracking Number:
0920-21CL
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
0920-20CL
Implementation of Health Programming in Schools Web Survey
Att 2_20 Min Survey.docx
Yes
Yes
Fillable Fileable
Form and Instruction
0920-21CL
Consortia Staff Qualitative Discussion Guide and Consent - 90 Min Consortia District Level Interview
Att 8_Verbal Consent Statement_90 min Interviews.docx
No
Fillable Fileable
Form
0920-21CL
Consortia Staff Qualitative Discussion Guide and Consent - 90 Min Consortia School Administrators
Att 8_Verbal Consent Statement_90 min Interviews.docx
No
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
521
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
0 %
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
521
0
521
0
0
0
Annual IC Time Burden (Hours)
286
0
286
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Authorizing Legislation
Att 1_Auth Legislation.docx
01/27/2021
SSA
SSA-consortia_1_15_2021.docx
01/27/2021
SSB
SSB-consortia.docx
01/27/2021
Att 9_IRB Approval
Att 9_IRB Approval.docx
01/27/2021
Att 14_Consultants
Att 14_Consultants.docx
01/27/2021
60 Day FRN
Att 13_60 Day FRN.pdf
01/27/2021
Att 12_Respondent Universe
Att 12_Respondent Universe.docx
01/27/2021
Att 2a_Survey screenshots
Att 2a_Survey screenshots.pdf
01/29/2021
Att 3_Consortia Staff Qualitative Discussion Guide
Att 3_Consortia Staff Qualitative Discussion Guide.docx
01/29/2021
Att 5_ Survey Invitation Letter
Att 5_ Survey Inviation Letter.docx
01/29/2021
Att 6_Consortia_District_ StakeholderIdentification
Att 6_Consortia_District_ StakeholderIdentification.docx
01/29/2021
IRB Approval
Att 9_IRB Approval.docx
01/29/2021
Att 10_Invitation Letter for Interviews
Att 10_Invitation Letter for Interviews.docx
01/29/2021
Att 12_Respondent Universe
Att 12_Respondent Universe.docx
01/29/2021
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.