Evaluation of the Young Sisters Initiative: A Guide to A Better You! Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
YSI Program Users (Post-Use Survey)	Form	New	Available
YSI Program Users (Demographic Screener)	Form	New	Available
Part B Supporting Statement_ 9 26 2012.doc	Supporting Statement B	Uploaded 2012-09-27	Available
Att 2B_Summary of Public Comments_9 17 2012.doc	Supplementary Document	Uploaded 2012-09-27	Available
Att 2A_Federal Register Notice_9 17 2012.pdf	Supplementary Document	Uploaded 2012-09-27	Available
Att 1_Authorizing Legislation PHSA_9 17 2012.doc	Supplementary Document	Uploaded 2012-09-27	Available
Att 5B_Full Version YSI Program Post-Use Survey_ 9 17 2012.docx	Supplementary Document	Uploaded 2012-09-27	Available
Att 4B_Full Version YSI Program Demographic Screener_10 05 2012.doc	Supplementary Document	Uploaded 2012-10-05	Available
Att 3C_Follow Up Reminder_9 17 2012.doc	Supplementary Document	Uploaded 2012-09-27	Available
Att 3B_YSI Landing Page_9 17 2012.pdf	Supplementary Document	Uploaded 2012-09-27	Available
Att 3A_YSI Announcement_ 9 17 2012.doc	Supplementary Document	Uploaded 2012-09-27	Available
Part A Supporting Statement_9 26 2012.doc	Supporting Statement A	Uploaded 2012-09-27	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
204464	YSI Program Users (Post-Use Survey)	Form	New
204463	YSI Program Users (Demographic Screener)	Form	New

ICR Details

OMB Control No: 0920-0951	ICR Reference No: 201210-0920-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Evaluation of the Young Sisters Initiative: A Guide to A Better You! 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 without change	Conclusion Date: 12/11/2012
	Date Received in OIRA: 10/11/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2013	12 Months From Approved
Responses	800	0	0
Time Burden (Hours)	142	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: As part of the Breast Cancer in Young Women (BCYW) initiative, CDC plans to collect the information needed to conduct a process evaluation of a new web-based program for African American women, the Young Sisters Initiative.

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: The Public Health Service Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 33460	06/06/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 61410	10/09/2012
Did the Agency receive public comments on this ICR? Yes

---

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

table that charts list of burden

IC Title	Form No.	Form Name
YSI Program Users (Demographic Screener)	none	Demographic Screener Screenshots
YSI Program Users (Post-Use Survey)	none	Post-Use Survey Screenshots

---

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	800	0	0	800	0	0
Annual Time Burden (Hours)	142	0	0	142	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 request.

---

Annual Cost to Federal Government: $15,000

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

---

Common Form ICR:  No

---

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: 10/11/2012

---