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Student Identification and Referral Form
 
No New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Student Identification and Referral Form Student Identification and Referral Form Att.M_SIRF for OMB_CLEAN_05292024.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

Privacy Act of 1974 (Title 5 United States Code [U.S.C.] 552a)   75 FR 28264

47 0
   
State, Local, and Tribal Governments
 
   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 4,700 0 4,700 0 0 0
Annual IC Time Burden (Hours) 2,350 0 2,350 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement A 4. Project AWARE-TISS Cross-Site Evaluation Part A.docx 04/08/2024
Supporting Statement B 5. Project AWARE-TISS Cross-Site Evaluation Part B.docx 04/08/2024
Data Access and Use Agreement Att.N_ ATODS DUA for OMB_Final Clean_09062023.docx 04/08/2024
Cross-Site Evaluation Questions ATT.O_Project AWARE-TISS Cross-Site Evaluation Questions for OMB_Final Clean_09062023.docx 04/08/2024
Detailed Description of AWARE TISS Evaluation Components ATT.P_Detailed Description of Project AWARE-TISS Cross-Site Evaluation Components for OMB_Final Clean_09062023.docx 04/08/2024
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.