Children's Peer Relations and the Risk for Injury at School

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 4 Injury Abstraction Form	Form	New	Repair queued
Form 3 Social Behavior Rating Scale	Form	New	Repair queued
Form 2 Peer Nomination Inventory Form--"Others at School"	Form	New	Repair queued
Form 1 Demographic Checklist--"All About You"	Form	New	Repair queued
SS Part B.11-10.doc	Supporting Statement B	Uploaded 2008-11-24	Repair queued
Justification for expedited review of ICR by OMB.doc	Supplementary Document	Uploaded 2008-12-15	Repair queued
Attachment N-Script for Demographic and Peer Nomination Data Collection with Children.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment M-School Injury Assent Form (2).11.10.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment L-Reminder letter to parents.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment K-School Injury Parental Permission Form 2_11-10.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment J-Intro letter to parents- 11-10.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment I-Intro letter to teachers_Robin Toblin edits 11-18.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment H-Table Shells.xls	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment G_5458 IRB Approval of New Protocol (Expedited) .txt	Supplementary Document	Uploaded 2008-11-24	Repair queued
Attachment A-TITLE 42--THE PUBLIC HEALTH AND WELFARE.doc	Supplementary Document	Uploaded 2008-11-24	Repair queued
SS Part A 12.12.08.doc	Supporting Statement A	Uploaded 2008-12-17	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
187734	Injury Abstraction Form	Form	New
187733	Social Behavior Rating Scale	Form	New
187732	Peer Nomination Inventory Form--"Others at School"	Form	New
187731	Demographic Checklist--"All About You"	Form	New

ICR Details

OMB Control No:	ICR Reference No: 200901-0920-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Children's Peer Relations and the Risk for Injury at School
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OIRA Conclusion Action: Withdrawn	Conclusion Date: 04/08/2009
	Date Received in OIRA: 01/06/2009
Terms of Clearance: Withdrawn consistent with agency memo received 04/02/2009. OMB acknowledges that the program plans to resubmit this collection in the fall so that data collection can begin in early 2010. Unless there are substantive changes to the package (scope, burden, data elements, etc.), OMB agrees to an expedited notice and comment period of 30 days. If there are substantive changes to the package, the program has agreed to go through the normal notice and comment period. If these terms of clearance are violated, the package will be returned as "improperly submitted."

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		12 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is an epidemiologic study of injuries incurred at school and their relation to elementary school children's peer relationships. This study has two main research goals: 1. To describe the epidemiology of all school health room injuries in an American elementary school with an ethnically diverse population and 2. To understand the association between children's peer relations and a child's injury risk using regression modeling. The information gathered by this study will lead to more informed, evidence-based childhood injury prevention interventions or interventions on associated characteristics (for example, bullying prevention or social skills) that will, in turn, reduce injury risk. For instance, if results indicate that children with poor peer relationships are at greater risk for injury, future interventions such as teaching children better social skills may help reduce injury burden at school. By exploring modifiable behavioral risk factors, interventions with children determined to be at risk can be examined for their efficacy when resources do not permit universal prevention programs.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: The Public Health and Welfare
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 8319	02/13/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 73333	12/02/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Demographic Checklist--"All About You"	1	All About You
Peer Nomination Inventory Form--"Others at School"	2	Others at School
Social Behavior Rating Scale	3	Social Behavior Rating Scale
Injury Abstraction Form	4	Injury Abstraction Form

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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 ICR.

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Annual Cost to Federal Government: $14,353

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)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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: 01/06/2009

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