Measuring Preferences for Quality of Life for Child Maltreatment

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form Attachment D Measuring Preferences for Quality of Life for Child Maltreatment Survey Instrument: Ages 18+	Form and Instruction	New	Available
Form Attachment D Measuring Preferences for Quality of Life for Child Maltreatment Survey Instrument: Ages 18-29	Form and Instruction	New	Available
Attachment I - Pretest Report.docx	Supplementary Document	Uploaded 2012-04-23	Available
SSB - Clean 3-29-2012.docx	Supporting Statement B	Uploaded 2012-04-03	Available
Attachment G - IRB Renewal 2012.pdf	Supplementary Document	Uploaded 2012-04-03	Available
Attachment F_IRB-Consent-Form.docx	Supplementary Document	Uploaded 2012-04-03	Available
Attachment C_Survey-Invitation.docx	Supplementary Document	Uploaded 2012-04-03	Available
Attachment E_Survey-Instrument.docx	Supplementary Document	Uploaded 2012-04-03	Available
Attachment E_Survey-Instrument.docx	Supplementary Document	Uploaded 2012-04-03	Available
SSA - Clean 3-29-2012.docx	Supporting Statement A	Uploaded 2012-04-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
201913	Measuring Preferences for Quality of Life for Child Maltreatment Survey Instrument: Ages 18+	Form and Instruction	New
201912	Measuring Preferences for Quality of Life for Child Maltreatment Survey Instrument: Ages 18-29	Form and Instruction	New

ICR Details

OMB Control No: 0920-0930	ICR Reference No: 201204-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Measuring Preferences for Quality of Life for Child Maltreatment
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: 04/23/2012
	Date Received in OIRA: 04/11/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2014	24 Months From Approved
Responses	1,850	0	0
Time Burden (Hours)	771	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The US Department of Health and Human Services, among many others, has identified child maltreatment as a serious U.S. public health problem with substantial long-term physical and psychological consequences. Despite considerable qualitative research on the consequences of CM in adults, few studies have utilized standardized HRQOL techniques and none have quantified childhood HRQOL impacts. This gap in the literature means the full burden of CM on HRQOL has not been measured, inhibiting the evaluation of CM intervention programs and comparisons to other public health issues. This exploratory research study will improve public health knowledge and economic evaluation of the HRQOL impacts of CM, including effects specific to juvenile and adolescent victims, through the development and fielding a preference-based survey instrument. CDC has developed an exploratory survey instrument to quantify the HRQOL impacts of child maltreatment following standardized HRQOL methods. The survey was developed based on findings from a literature review of CM outcomes, focus groups with adults who were CM victims, and expert review of outcomes by clinician consultants who work with children and/or adults who were victims of CM, or who are researchers in the field of CM. The survey is designed to quantify two types of data. The main objective is the HRQOL decrement attributable to CM, measured as the difference in HRQOL scores by CM victimization history. A secondary objective is a statistical evaluation of these decrements, based on respondent preferences over a series of comparisons that will be shown to survey respondents.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: General Powers and Duties of Public Health Service
  

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 67092	11/01/2010
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 60497	09/29/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Measuring Preferences for Quality of Life for Child Maltreatment Survey Instrument: Ages 18-29	Attachment D	Childhood Experiences Survey
Measuring Preferences for Quality of Life for Child Maltreatment Survey Instrument: Ages 18+	Attachment D	Childhood Experiences 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	1,850	0	0	1,850	0	0
Annual Time Burden (Hours)	771	0	0	771	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 ICR being resubmitted because OMB requested revisions.

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Annual Cost to Federal Government: $182,189

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: 04/11/2012

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