Youth Advice and Feedback to Inform Choose Respect Implementation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Att N_--_Focus_Group_Survey_REV 6 17 09.doc	Supplementary Document	Uploaded 2009-06-19	Available
Att M_--_Focus_Group_Screening_Instrument_for_Parents_and_Youth REV 6 17 09.doc	Supplementary Document	Uploaded 2009-06-19	Available
Att L_--_Youth_Assent_Form_for_Focus_Groups_REV_6 17 09.doc	Supplementary Document	Uploaded 2009-06-19	Available
Att F_--_Online_Survey_Screening_Instrument_for_Parents_REV_6 17 09.doc	Supplementary Document	Uploaded 2009-06-19	Available
Att D_--_Focus_Group_Moderator's_Guide_REV 6 17 09.doc	Supplementary Document	Uploaded 2009-06-19	Available
Att C_--_Online_Survey_v2_REV_6 17 09.doc	Supplementary Document	Uploaded 2009-06-19	Available
Att N_--_Focus_Group_Survey_REV 6 17 09.doc	Supplementary Document	Uploaded 2009-06-18	Repair queued
Att M_--_Focus_Group_Screening_Instrument_for_Parents_and_Youth REV 6 17 09.doc	Supplementary Document	Uploaded 2009-06-18	Available
Att L_--_Youth_Assent_Form_for_Focus_Groups_REV_6 17 09.doc	Supplementary Document	Uploaded 2009-06-18	Repair queued
Att F_--_Online_Survey_Screening_Instrument_for_Parents_REV_6 17 09.doc	Supplementary Document	Uploaded 2009-06-18	Available
Att D_--_Focus_Group_Moderator's_Guide_REV 6 17 09.doc	Supplementary Document	Uploaded 2009-06-18	Available
Att C_--_Online_Survey_v2_REV_6 17 09.doc	Supplementary Document	Uploaded 2009-06-18	Available
SS_Part B_final_1-26-09.doc	Supporting Statement B	Uploaded 2009-02-02	Available
Att.J -- IRB Approval Letter_final 1-26-09.doc	Supplementary Document	Uploaded 2009-02-02	Available
Att.O -- FW public comment on federal register of 21208 vol 73 #29 pg 8045 dhs cdc 08AP.htm	Supplementary Document	Uploaded 2009-02-02	Available
Att.B -- 60d FRN.pdf	Supplementary Document	Uploaded 2009-02-02	Available
Att.A -- Section 301 of the Public Health Services Act.doc	Supplementary Document	Uploaded 2009-02-02	Available
Att.K -- Parental Permission Form for Focus Groups_final_ 1-26-09.doc	Supplementary Document	Uploaded 2009-02-02	Repair queued
Att.L -- Youth Assent Form for Focus Groups_REV 1-9-09.doc	Supplementary Document	Uploaded 2009-02-02	Available
Att.I -- Online Survey Youth Assent Form v3_final_1-26-09.doc	Supplementary Document	Uploaded 2009-02-02	Available
Att.E -- Onilne Survey Email Invitation_final_1-26-09.doc	Supplementary Document	Uploaded 2009-02-02	Available
Att.G_ Online Survey Parental Permission Form._1-26-09.doc	Supplementary Document	Uploaded 2009-02-02	Repair queued
SS_Part_A_final_REV 6 17 09.doc	Supporting Statement A	Uploaded 2009-06-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188377	Focus Group Survey	Other-WORD	New
188376	Focus Group Screening Instrument for Parents and Youth	Other-WORD	New
188375	Online Screening Instrument for Youth	Other-WORD	New
188374	Online Survey Email and Online Survey Screening for Parents	Other-WORD	New
188373	Focus Group Moderator's Guide	Other-WORD	New
188372	Online Survey	Other-WORD	New

ICR Details

OMB Control No: 0920-0816	ICR Reference No: 200903-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Youth Advice and Feedback to Inform Choose Respect Implementation
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: 06/26/2009
	Date Received in OIRA: 03/10/2009
Terms of Clearance: Approved consistent with modifications uploaded on 6/19/2009.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved
Responses	6,304	0	0
Time Burden (Hours)	1,354	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Psychological and physical abuse occurs in as many as one in three adolescent dating relationships. The Centers for Disease Control and Prevention (CDC) has included among its top research priorities efforts to prevent intimate partner violence. In 2006, it's National Center for Injury Prevention and Control introduced the Choose Respect initiative to help 11- to 14-year olds to form health relationships to prevent dating abuse. The initiative is designed to encourage youth to treat themselves and other with respect; increase their ability to recognize/prevent unhealthy relationships; and promote access of prevention information/tools. CDC is seeking to conduct audience research to test creative concepts/messages/ materials and planned communication strategies/tactics. Feedback will be used to revise/enhance campaign implementation and ensure that it effectively reaches its audience.

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

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 8045	02/12/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 6161	02/05/2009
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Focus Group Moderator's Guide
Online Survey Email and Online Survey Screening for Parents
Online Screening Instrument for Youth
Focus Group Screening Instrument for Parents and Youth
Focus Group Survey
Online Survey

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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	6,304	0	0	6,304	0	0
Annual Time Burden (Hours)	1,354	0	0	1,354	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 information collection request.

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Annual Cost to Federal Government: $384,665

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: 03/10/2009

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