Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
SS Part B.2010.docx	Supporting Statement B	Uploaded 2010-08-25	Available
Attach O Response to Public Comment.pdf	Supplementary Document	Uploaded 2010-08-25	Available
Attach P Public Comment.docx	Supplementary Document	Uploaded 2010-08-25	Available
Attach J-2 IRB Approval of Continuation of Protocol 4-28-10.doc	Supplementary Document	Uploaded 2010-08-25	Repair queued
Attach J-1 IRB Approval Letter REV 1-9-09 REV 4-28-10.doc	Supplementary Document	Uploaded 2010-08-25	Available
Att B_60d FRN.pdf	Supplementary Document	Uploaded 2010-08-25	Available
Attach A - Section 301 of the Public Health Services Act ORIG 10-08.doc	Supplementary Document	Uploaded 2010-08-25	Available
Att.K -- Parental Permission Form for Focus Groups_final_ 1-26-09.doc	Supplementary Document	Uploaded 2009-02-02	Available
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
SS Part A_2010.docx	Supporting Statement A	Uploaded 2010-08-25	Available

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0920-0816	ICR Reference No: 201009-0920-001
Status: Historical Active	Previous ICR Reference No: 200903-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/23/2010
	Date Received in OIRA: 09/02/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2013	36 Months From Approved	06/30/2012
Responses	6,304	0	6,304
Time Burden (Hours)	1,354	0	1,354
Cost Burden (Dollars)	0	0	0

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Abstract: This Information Collection Request (ICR) is a revision of previously approved OMB# 0920-0816. This is a three year study and includes a revision to the study name from, "Youth Advice and Feedback to Inform Choose Respect Implementation" to, "Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation". The proposed participants are youth, ages 1l to 18, specifically youth living in high-risk, inner-city communities (YHRICC). This research will be conducted because CDC's Division of Violence Prevention is developing an initiative to promote respectful, nonviolent dating relationships for 11- to 14-year-old YHRICC--a group that may be at an increased risk of teen dating violence (TDV) due to concentrated poverty, lack of resources, and exposure to community violence (2010a). In addition, few, if any, TDV prevention programs exist for this audience. As part of the initiative, CDC plans to engage 15- to 18-year-olds who have significant influence on their younger peers (CDC, 2010b), to help reinforce messages about healthy dating relationships. This is why 15- to 18-year-olds will also participate in the proposed information collections.

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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:
	75 FR 20849	04/21/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 38104	07/01/2010
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
Online Survey
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

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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	6,304	0	0	0	0
Annual Time Burden (Hours)	1,354	1,354	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $568,528

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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 09/02/2010

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