Girls at Greater Risk for Juvenile Delinquency and HIV Prevention Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Community Residents Form	Form	Modified	Available
Form 1 Partners Focus Group Background Form	Form	Modified	Available
Form 1 Partners Focus Group Protocol	Form and Instruction	Modified	Available
Form 1 Partners Process Evaluation Form	Form	Modified	Available
Form 1 Program Directors Process Evaluation Form	Form	Modified	Available
Form 1 Staff Process Evaluation Form	Form	Modified	Available
Form 1 Participants Focus Group Protocol	Form and Instruction	Modified	Available
Form 1 Participants Focus Group Background Form	Form	Modified	Available
Form 1 Program Participants Parents Focus Group Background Form	Form	Modified	Available
Form 1 Program Participants Parents Focus Group Protocol	Form and Instruction	Modified	Available
Form 5 Post-Test Form for Participants aged 12-17	Form	Modified	Available
Form 4 Pre-Test Form for Participants aged 12-17	Form	Modified	Available
Form 3 Follow-up Form for Participants aged 9-11	Form	Modified	Available
Form 2 Post-Test Form for Participants aged 9-11	Form	Modified	Available
Form 1 Pre-Test Form for Participants aged 9-11	Form	Modified	Available
Form 6 Follow-Up Form for Participants aged 12-17	Form	Modified	Available
0990-Girls at risk SS Part B.doc	Supporting Statement B	Uploaded 2010-09-24	Available
OMB Responses September 27 2010.docx	Supplementary Document	Uploaded 2010-09-27	Available
0990-GirlsAppendix_A 2_Contact_Information-OWH_Contractors_(JD_only)[1].doc	Supplementary Document	Uploaded 2010-09-26	Available
0990-Girls at Greater Risk Supporting Statement A revised per OMB request 9_20_10 final[1].doc	Supporting Statement A	Uploaded 2010-09-24	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194099	Community Residents	Form	Modified	Community Residents Form
194098	Program Partners - Focus group	Form	Modified	Partners Focus Group Background Form
194098	Program Partners - Focus group	Form and Instruction	Modified	Partners Focus Group Protocol
194097	Program Partners- Process Interviews	Form	Modified	Partners Process Evaluation Form
194096	Program Directors- Process Evaluation Interview: Program Directors	Form	Modified	Program Directors Process Evaluation Form
194095	Program Staff- Process Evaluation Interview	Form	Modified	Staff Process Evaluation Form
194094	test	Other-List of partners	Modified
194093	Program Participants Focus Group (Girls and Female Adolescents)	Form and Instruction	Modified	Participants Focus Group Protocol
194093	Program Participants Focus Group (Girls and Female Adolescents)	Form	Modified	Participants Focus Group Background Form
194092	Parents of Program Partcipants - Focus Group	Form	Modified	Program Participants Parents Focus Group Background Form
194092	Parents of Program Partcipants - Focus Group	Form and Instruction	Modified	Program Participants Parents Focus Group Protocol
194091	Program Participants (girl and female adolescents)	Form	Modified	Post-Test Form for Participants aged 12-17
194091	Program Participants (girl and female adolescents)	Form	Modified	Pre-Test Form for Participants aged 12-17
194091	Program Participants (girl and female adolescents)	Form	Modified	Follow-up Form for Participants aged 9-11
194091	Program Participants (girl and female adolescents)	Form	Modified	Post-Test Form for Participants aged 9-11
194091	Program Participants (girl and female adolescents)	Form	Modified	Pre-Test Form for Participants aged 9-11
194091	Program Participants (girl and female adolescents)	Form	Modified	Follow-Up Form for Participants aged 12-17

ICR Details

OMB Control No: 0990-0360	ICR Reference No: 201009-0990-004
Status: Historical Active	Previous ICR Reference No: 201009-0990-001
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Girls at Greater Risk for Juvenile Delinquency and HIV Prevention Program
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: 09/27/2010
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/27/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2013	36 Months From Approved
Responses	2,211	0	0
Time Burden (Hours)	3,652	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The primary goal of OWH's Girls at Greater Risk program is to increase knowledge about HIV and other sexually transmitted infections (STIs) and individual protective factors against juvenile delinquency among girls between the ages of 9 and 17 years using gender responsive prevention strategies. The program targets those behaviors and attitudes that have been found to promote both juvenile delinquency and sexually risky behavior.

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Authorizing Statute(s): PL: Pub.L. 105 - 277 2681 Name of Law: Omnibus Consolidated and Emergency Supplemental Appropriations Act 1999
  

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 15432	03/29/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 45116	08/02/2010
Did the Agency receive public comments on this ICR? No

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

table that charts list of burden

IC Title	Form No.	Form Name
Community Residents	1	Community Residents Form
Parents of Program Partcipants - Focus Group	1, 1	Program Participants Parents Focus Group Protocol ,   Program Participants Parents Focus Group Background Form
Program Directors- Process Evaluation Interview: Program Directors	1	Program Directors Process Evaluation Form
Program Participants (girl and female adolescents)	1, 2, 3, 4, 5, 6	Pre-Test Form for Participants aged 9-11 ,   Post-Test Form for Participants aged 9-11 ,   Follow-up Form for Participants aged 9-11 ,   Pre-Test Form for Participants aged 12-17 ,   Post-Test Form for Participants aged 12-17 ,   Follow-Up Form for Participants aged 12-17
Program Participants Focus Group (Girls and Female Adolescents)	1, 1	Participants Focus Group Background Form ,   Participants Focus Group Protocol
Program Partners - Focus group	1, 1	Partners Focus Group Protocol ,   Partners Focus Group Background Form
Program Partners- Process Interviews	1	Partners Process Evaluation Form
Program Staff- Process Evaluation Interview	1	Staff Process Evaluation Form
test

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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	2,211	0	0	2,211	0	0
Annual Time Burden (Hours)	3,652	0	0	3,652	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 data collection.

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Annual Cost to Federal Government: $307,306

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]? 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: 09/27/2010

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