Evaluation of the Safe Dates Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Draft MEMORANDUM.doc	Supplementary Document	Uploaded 2008-06-17	Available
Supporting Statement B.doc	Supporting Statement B	Uploaded 2007-12-05	Available
SafeDates_OMB_Appendix-G.doc	Supplementary Document	Uploaded 2007-12-18	Available
SafeDates_OMB_Appendix-F.doc	Supplementary Document	Uploaded 2007-12-18	Available
SafeDates_OMB_Appendix-A.doc	Supplementary Document	Uploaded 2007-12-05	Available
SafeDates_OMB_Appendix-I.doc	Supplementary Document	Uploaded 2007-12-18	Available
SafeDates_OMB_Appendix-H.doc	Supplementary Document	Uploaded 2007-12-18	Available
Apx B1 Mid-Implementation Survey Program Coordinator.doc	Supplementary Document	Uploaded 2007-12-05	Repair queued
SafeDates_OMB_Appendix-J.doc	Supplementary Document	Uploaded 2007-12-18	Repair queued
Supporting Statement A.doc	Supporting Statement A	Uploaded 2007-12-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183247	Evaluation of the Safe Dates Project - Effectivness Follow-up Survey	Instruction	New
183246	Evaluation of the Safe Dates Project - Follow-Up Prevention Coordinator Survey	Instruction	New
183245	Evaluation of the Safe Date Project - Teacher Fifth and Teacher Ninth Session Mid-Implementation Survey	Instruction	New
183244	Evaluation of the Safe Dates Project - Student Effectiveness Baseline Survey	Instruction	New
183243	Evaluation of the Safe Date Project - First Student and Second Student Mid-Implementation Survey	Instruction	New
183242	Principal and Prevention Coordinator End-of-Year Implementation Survey	Instruction	New
183241	Teacher Cost Survey	Instruction	New
183240	Evaluation of the Safe Dates Project - Principle and Prevention Coordinator Mid-Implementation Survey	Instruction	New
183239	Evaluation of the Safe Dates Project - Principle, Prevention Coordinator and Teacher Baseline Implementation Survey	Instruction	New

ICR Details

OMB Control No: 0920-0783	ICR Reference No: 200801-0920-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the Safe Dates Project
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/30/2008
	Date Received in OIRA: 01/03/2008
Terms of Clearance: Approved consistent with revisions outlined in CDC memo submitted to OMB and included in the public docket.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2011	36 Months From Approved
Responses	26,846	0	0
Time Burden (Hours)	14,113	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: Teen dating violence is a major public health problem that affects all strata of society and all major social institutions, icluding the medical and mental health care, social services, economic and criminal justice systems. The specific aims of this study are to describe the implementation and drivers of implementation of the Safe Dates program (implementation evaluation): to evaluate its impact on desired outcomes, including prevention of and reduction in dating violence victimization and prepetraion (including psychological abuse, stalking, physical violence, and sexual violence) among ninth-grade students (experimental effectiveness evaluation): and to evaluate its cost-effectiveness, including cost-utility (cost evaluation).

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 2697	01/22/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 64651	11/16/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Evaluation of the Safe Date Project - Teacher Fifth and Teacher Ninth Session Mid-Implementation Survey
Evaluation of the Safe Dates Project - Follow-Up Prevention Coordinator Survey
Evaluation of the Safe Dates Project - Effectivness Follow-up Survey
Evaluation of the Safe Dates Project - Principle, Prevention Coordinator and Teacher Baseline Implementation Survey
Evaluation of the Safe Dates Project - Principle and Prevention Coordinator Mid-Implementation Survey
Teacher Cost Survey
Principal and Prevention Coordinator End-of-Year Implementation Survey
Evaluation of the Safe Date Project - First Student and Second Student Mid-Implementation Survey
Evaluation of the Safe Dates Project - Student Effectiveness Baseline Survey

---

ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	26,846	0	0	26,846	0	0
Annual Time Burden (Hours)	14,113	0	0	14,113	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new request.

---

Annual Cost to Federal Government: $601,155

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 01/03/2008

---