A Controlled Evaluation of Expect Respect Support Groups (ERSG): Preventing and Interrupting Teen Dating Violence among At-Risk Middle and High School Students

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 5 Teen Dating Violence Support Group Evaluation Survey (Baseline Survey)	Form and Instruction	New	Repair queued
Form 4 Intake Assessment Screening Form for Expect Respect Support Groups (Intake Assessment)	Form	New	Repair queued
Form 1 Teen Dating Violence Support Group Evaluation Survey (Completion Survey)	Form and Instruction	New	Repair queued
Form 1 Teen Dating Violence Support Group Evaluation Survey (12-Month Follow Up Survey)	Form and Instruction	New	Repair queued
Form 1 Teen Dating Violence Support Group Evaluation Survey (18-Month Follow Up Survey)	Form and Instruction	New	Repair queued
ERSG OMB Part B Updated 2.9.10 - clean.docx	Supporting Statement B	Uploaded 2010-02-25	Repair queued
Attachment H - Expect Respect Safety Procedures and Mandatory Reporting Requirements.pdf	Supplementary Document	Uploaded 2010-03-15	Repair queued
Attachment G - Student Assent.pdf	Supplementary Document	Uploaded 2010-02-25	Repair queued
Attachment F - IRB Approval.pdf	Supplementary Document	Uploaded 2010-02-25	Repair queued
ERSG OMB Part A Revised 2.9.10 - clean.docx	Supporting Statement A	Uploaded 2010-02-25	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
192230	Teen Dating Violence Support Group Evaluation Survey (Baseline Survey)	Form and Instruction	New
192229	Intake Assessment Screening Form for Expect Respect Support Groups (Intake Assessment)	Form	New
192228	Teen Dating Violence Support Group Evaluation Survey (Completion Survey)	Form and Instruction	New
192227	Teen Dating Violence Support Group Evaluation Survey (12-Month Follow Up Survey)	Form and Instruction	New
192226	Teen Dating Violence Support Group Evaluation Survey (18-Month Follow Up Survey)	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201003-0920-005
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: A Controlled Evaluation of Expect Respect Support Groups (ERSG): Preventing and Interrupting Teen Dating Violence among At-Risk Middle and High School Students
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: 06/02/2010
	Date Received in OIRA: 03/11/2010
Terms of Clearance: CDC will resubmit this package after IRB approval is granted for revised consent forms. In the meantime, CDC may work with OMB to address additional concerns raised during the course of review.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The prevalence and consequences of teen dating violence make it a public health concern that requires early and effective prevention. To date, only three prevention strategies -- Safe Dates, the Youth Relationships Project, and 4th R - have demonstrated reductions in dating violence behaviors in rigorous, controlled evaluations. In order to protect young people and build an evidence-base of effective prevention strategies, evaluation of additional programs is needed, including those programs currently in the field. Expect Respect Support Groups (developed and currently provided by SafePlace) is currently in use in the Austin Independent School District. The ERSG has demonstrated favorable, albeit preliminary, results in an uncontrolled program evaluation, which strongly suggests that a controlled evaluation is needed to more rigorously examine program effects. The proposed study has two primary goals and two exploratory aims. The primary goals are: 1. To evaluate the effectiveness of Expect Respect Support Groups (ERSG) in preventing and reducing teen dating violence and 2. Comparing whether there is increased healthy conflict resolution skills reported by at-risk male and female middle and high school students supported by ERSG, compared to at-risk students in control schools who do not receive ERSG. The exploratory aims are: 1) To evaluate whether or not the effectiveness of ERSG is enhanced by the presence of a universal, school-wide prevention programs, and 2) To examine whether participants with different characteristics respond differently to the intervention. For example, we will determine whether outcome for boys or girls are the same.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Research and Investigations Generally
  

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:
	74 FR 38634	08/04/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 8724	02/25/2010
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
Teen Dating Violence Support Group Evaluation Survey (18-Month Follow Up Survey)	1	Completion and Follow-Ups for 12 Months and 18 Months Evaluation Survey
Teen Dating Violence Support Group Evaluation Survey (12-Month Follow Up Survey)	1	Completion and Follow-Ups for 12 Months and 18 Months Evaluation Survey
Teen Dating Violence Support Group Evaluation Survey (Completion Survey)	1	Completion and Follow-Ups for 12 Months and 18 Months Evaluation Survey
Intake Assessment Screening Form for Expect Respect Support Groups (Intake Assessment)	4	Intake Assessment Screening Form for Expect Respect Support Groups (Intake Assessment)
Teen Dating Violence Support Group Evaluation Survey (Baseline Survey)	5	Teen Dating Violence Support Group Evaluation Survey (Baseline Survey)

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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 submission.

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Annual Cost to Federal Government: $242,442

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? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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: 03/11/2010

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