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Healthy Students Questionnaire
[NCCDPHP] Healthy Schools Program Evaluation
OMB: 0920-1455
IC ID: 270338
OMB.report
HHS/CDC
OMB 0920-1455
ICR 202504-0920-011
IC 270338
( )
Documents and Forms
Document Name
Document Type
Form 0920-24BJ
Healthy Students Questionnaire
Form
0920-24BJ Healthy Student Questionnaire
Attachment 11 - Healthy Student Questionnaire (highlighted for EO revision) 2025.05.02.docx
Form
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Healthy Students Questionnaire
Agency IC Tracking Number:
0920-24BJ
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
0920-24BJ
Healthy Student Questionnaire
Attachment 11 - Healthy Student Questionnaire (highlighted for EO revision) 2025.05.02.docx
Yes
Yes
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:
13,150
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Requested
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
13,150
0
0
0
0
13,150
Annual IC Time Burden (Hours)
6,575
0
0
0
0
6,575
Annual IC Cost Burden (Dollars)
0
0
0
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.
