Evaluation of the Safe Dates Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Supporting Statement B - CLEAN.docx	Supporting Statement B	Uploaded 2010-12-21	Available
Attachment K - Public Comment.docx	Supplementary Document	Uploaded 2010-09-23	Available
Attachment G - Statement of Agreement.docx	Supplementary Document	Uploaded 2010-09-23	Available
Attachment C - IRB Approval Notice.pdf	Supplementary Document	Uploaded 2010-09-21	Available
Attachment C__IRB_Request_for_Exemption_approval_2_12_10_2.pdf	Supplementary Document	Uploaded 2010-09-21	Available
Attachment B - Published 60-Day FRN.pdf	Supplementary Document	Uploaded 2010-09-21	Available
Attachment A Authorizing Legislation.doc	Supplementary Document	Uploaded 2010-09-21	Available
Attachment D - Student Privacy Pledge.doc	Supplementary Document	Uploaded 2010-09-23	Repair queued
Attachment H - Parent Brochure.docx	Supplementary Document	Uploaded 2010-09-23	Available
Attachment I - Safe Dates Student Assent.docx	Supplementary Document	Uploaded 2010-09-23	Available
Attachment E - Lead Letter to Parents.docx	Supplementary Document	Uploaded 2010-09-23	Available
Supporting Statement A - CLEAN 12-14-10.docx	Supporting Statement A	Uploaded 2010-12-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
194858	Student Focus Group Guide	Other-Word	New
194857	Teacher Interview Guide	Other-WORD	New
183247	Student Effectivness Follow-up Survey	Other-WORD	Modified
183246	Follow-Up Prevention Coordinator Survey	Other-WORD	Modified
183245	Teacher 5th and 9th Session Mid-Implementation Survey	Other-WORD	Modified
183244	Student Effectiveness Baseline Survey	Other-WORD	Modified
183243	1st and 2nd Student Mid-Implementation Survey	Other-WORD	Modified
183242	Principal and Prevention Coordinator End-of-Year Implementation Survey	Other-ORD	Modified
183241	Teacher Cost Survey	Other-WORD	Modified
183240	Principle and Prevention Coordinator Mid-Implementation Survey	Other-WORD	Modified
183239	Principle, Prevention Coordinator and Teacher Baseline Survey	Other-WORD	Modified

ICR Details

OMB Control No: 0920-0783	ICR Reference No: 201010-0920-005
Status: Historical Active	Previous ICR Reference No: 200801-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the Safe Dates Project
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 12/22/2010
	Date Received in OIRA: 10/15/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2011	12 Months From Approved	06/30/2011
Responses	26,906	0	26,846
Time Burden (Hours)	14,193	0	14,113
Cost Burden (Dollars)	0	0	0

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Abstract: Teen dating violence is a major public health problem that affects all strata of society and all major social institutions, icluding the medical and mental health care, social services, economic and criminal justice systems. The specific aims of this study are to describe the implementation and drivers of implementation of the Safe Dates program (implementation evaluation): to evaluate its impact on desired outcomes, including prevention of and reduction in dating violence victimization and prepetraion (including psychological abuse, stalking, physical violence, and sexual violence) among ninth-grade students (experimental effectiveness evaluation): and to evaluate its cost-effectiveness, including cost-utility (cost evaluation).

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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 24958	05/06/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 185	09/24/2010
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
Principle and Prevention Coordinator Mid-Implementation Survey
Teacher Cost Survey
Principal and Prevention Coordinator End-of-Year Implementation Survey
Principle, Prevention Coordinator and Teacher Baseline Survey
1st and 2nd Student Mid-Implementation Survey
Student Effectiveness Baseline Survey
Teacher 5th and 9th Session Mid-Implementation Survey
Follow-Up Prevention Coordinator Survey
Student Effectivness Follow-up Survey
Teacher Interview Guide
Student Focus Group Guide

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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	26,906	26,846	0	60	0	0
Annual Time Burden (Hours)	14,193	14,113	0	80	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 revision of a currently approved ICR. The proposed information collection will add focus groups with students and interviews with teachers in schools with a new interview guide.

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Annual Cost to Federal Government: $157,364

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: 10/15/2010

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