Multi-Component Evaluation of the Bodyworks Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0990 Trainers of the Bodyworks program- trainer feedback forms	Form	New	Available
0990-BodyWorks_ss_PartB_111711.doc	Supporting Statement B	Uploaded 2011-11-18	Available
0990-BodyWorks_ss_PartA_111711.doc	Supporting Statement A	Uploaded 2011-11-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
198447	Trainers of the Bodyworks program- trainer feedback forms	Form	New
198446	Trainers of the Bodyworks program-Exit survey satisfaction interview	Other-survey	New
198445	Trainers of the Bodyworks program-Follow-up study interview	Other-study	New
198444	Trainers of the Bodyworks Program-Follow up study questionnaire	Other-questionnaire	New
198443	English and Spanish Bodywork Program comparison group participant-Follow-up	Other-evaluation	New
198442	English and Spanish Bodywork Program comparison group participant-posttest	Other-evaluation	New
198441	English and Spanish Bodywork Program comparison group participant-pretest	Other-evaluation	New
198440	Bodyworks program particpants -Feedback forms	Other-evaluation	New
198439	Bodyworks program particpants-English and Spanish Follow ups	Other-evaluation	New
198438	Bodyworks program particpants(english and spanish posttest	Other-survey	New
198437	Bodyworks program particpants(ENGLISH & SPANISH Pretest Evaluation)	Other-survey	New
198436	Bodyworks program particpants(English & Spanish Participant Exit Survey-Post Only Pilot Study)	Other-survey	New
198435	Bodyworks program particpants(Parent/Caregiver Followup Study Focus Group)	Other-Survey Focus Group	New
198434	Bodyworks program particpants(Parent/Caregiver Follow-up Study Questionnaire)	Other-questionaire	New

ICR Details

OMB Control No: 0990-0385	ICR Reference No: 201107-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Multi-Component Evaluation of the Bodyworks 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: 12/12/2011
	Date Received in OIRA: 07/07/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2014	36 Months From Approved
Responses	6,411	0	0
Time Burden (Hours)	1,409	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a study of the BodyWorks program, which is a federally funded program that is designed to help the parents of adolescents make healthy food choices and become more physically active. The program focuses on parents as role models and provides them with hands-on tools to make small, specific behavior changes by improving family eating and activity habits to prevent obesity among their children and help them achieve or maintain a healthy weight.

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Authorizing Statute(s): None

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:
	76 FR 9017	02/16/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 30363	05/25/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 14

table that charts list of burden

IC Title	Form No.	Form Name
Bodyworks program particpants(Parent/Caregiver Follow-up Study Questionnaire)
Bodyworks program particpants(Parent/Caregiver Followup Study Focus Group)
Bodyworks program particpants(English & Spanish Participant Exit Survey-Post Only Pilot Study)
Bodyworks program particpants(ENGLISH & SPANISH Pretest Evaluation)
Bodyworks program particpants(english and spanish posttest
Bodyworks program particpants-English and Spanish Follow ups
Bodyworks program particpants -Feedback forms
English and Spanish Bodywork Program comparison group participant-pretest
English and Spanish Bodywork Program comparison group participant-posttest
English and Spanish Bodywork Program comparison group participant-Follow-up
Trainers of the Bodyworks Program-Follow up study questionnaire
Trainers of the Bodyworks program-Follow-up study interview
Trainers of the Bodyworks program-Exit survey satisfaction interview
Trainers of the Bodyworks program- trainer feedback forms	0990	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	6,411	0	0	6,411	0	0
Annual Time Burden (Hours)	1,409	0	0	1,409	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: New collection

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Annual Cost to Federal Government: $153,138

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: 07/07/2011

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