Information Collection

Healthy Students Questionnaire

IC 270338 under ICR 202408-0920-014 · OMB 0920-1455.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1455 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-24BJ Healthy Students Questionnaire Form
0920-24BJ Healthy Student Questionnaire Attachment 11 - Healthy Student Questionnaire (final) 6.14.24.docx Form
0920-24BJ Healthy Student Questionnaire Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.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: 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	0920-24BJ	Healthy Student Questionnaire	Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx		Yes	Yes	Fillable Fileable

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 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	13,150	13,150
Annual IC Time Burden (Hours)	6,575	6,575
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.