Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Follow-up (Children)	Form and Instruction	New	Repair queued
Form 1 Posttest (Children)	Form and Instruction	New	Repair queued
Form 1 Pretest (Children)	Form and Instruction	New	Repair queued
Form 1 Assent (Children)	Form and Instruction	New	Repair queued
Form 1 Usage Log (Adults)	Form and Instruction	New	Repair queued
Form 1 Follow-up (Adults)	Form and Instruction	New	Repair queued
Form 1 Posttest (Adults)	Form and Instruction	New	Repair queued
Form 2 Pretest (Adults)	Form and Instruction	New	Repair queued
Form 1 Permission and Consent (Adults)	Form and Instruction	New	Repair queued
SSB Media Literacy.doc	Supporting Statement B	Uploaded 2013-06-11	Repair queued
Attach 11 Signed IRB Approval Letter.doc	Supplementary Document	Uploaded 2013-06-11	Repair queued
SSA Media Literacy.doc	Supporting Statement A	Uploaded 2013-06-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207386	Follow-up (Children)	Form and Instruction	New
207385	Posttest (Children)	Form and Instruction	New
207384	Pretest (Children)	Form and Instruction	New
207383	Assent (Children)	Form and Instruction	New
207382	Usage Log (Adults)	Form and Instruction	New
207381	Follow-up (Adults)	Form and Instruction	New
207380	Posttest (Adults)	Form and Instruction	New
207379	Pretest (Adults)	Form and Instruction	New
207378	Permission and Consent (Adults)	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 201306-0925-006
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 19767
Title: Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations
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: Improperly submitted	Conclusion Date: 07/17/2013
	Date Received in OIRA: 06/18/2013
Terms of Clearance: (1) Missing documentation: • Attachment 7 – Recruitment Text (see Supporting Statement B, “List of Attachments,” page iii). Sample text is included in the supporting statement, but no attachment was included. • A copy of the protocol that was submitted to the IRB. The approval letter alone is not sufficient. • Privacy Impact Assessment – (Supporting Statement B, page 5) discusses the Privacy Impact Assessment. Those materials were not included in the submission. • Print ads – (Supporting Statement B, on page 5 describes to print ads). Final versions of those ads were not (yet) included in the submission • Screenshots of web-based instruments (2) Questions about public-facing pproject collateral

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		09/30/2015
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: To evaluate a media literacy substance use prevention intervention for parents and their school-aged children, Media Detective Family (MDF). MDF reduces barriers to prevention efforts in rural areas by delivering the intervention on an interactive website or a mobile or wireless device. MDF focuses on improving children's alcohol and tobacco use knowledge and intentions, and adults' and children's media literacy knowledge and skills. A randomized controlled trial will be used to establish intervention effectiveness. Benefits will include improvements in critical thinking skills and parent-child communication about substances and the media, and an increase in rural families receiving evidence-based prevention programming.

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Authorizing Statute(s): US Code: 42 USC 6A (III) 15 Name of Law: NIDA
  

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:
	78 FR 18612	03/27/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 35040	06/11/2013
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
Permission and Consent (Adults)	1	Permission and Consent
Pretest (Adults)	2	Pretest
Posttest (Adults)	1	Posttest
Follow-up (Adults)	1	Follow-up
Usage Log (Adults)	1	Usage Log
Assent (Children)	1	Assent
Pretest (Children)	1	Pretest
Posttest (Children)	1	Posttest
Follow-up (Children)	1	Follow-up

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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.

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Annual Cost to Federal Government: $507,808

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: 06/18/2013

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