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 12 Child Followup	Form	New	Available
Form 11 Child Posttest	Form	New	Available
Form 10 Child Pretest	Form	New	Available
Form 6 Adults Usage Log	Form	New	Available
Form 5 Adult Follow-up	Form	New	Available
Form 4 Adult Post-test -Screenshot	Form	New	Available
Form 3 Adult Pretest -Screenshot	Form	New	Available
Form 2 Child Assent	Form and Instruction	New	Available
Form 1 Consent Form	Form and Instruction	New	Available
SSB.doc	Supporting Statement B	Uploaded 2013-11-06	Available
Attachment 13 Recruitment Materials.zip	Supplementary Document	Uploaded 2013-11-05	Available
Response to OMB Comments.docx	Supplementary Document	Uploaded 2013-10-28	Available
Attachment 17 Certification of Instructional Review Board.pdf	Supplementary Document	Uploaded 2013-10-28	Available
Attachment_11_-_Data_collection_instrument_-_Child_questionnaire_Followup_MDF[1].pdf	Supplementary Document	Uploaded 2013-11-06	Available
Attachment 9 - Data collection instrument - Child questionnaire Posttest MDF.pdf	Supplementary Document	Uploaded 2013-11-06	Available
Attachment_7_-_Data_collection_instrument_-_Child_questionnaire_Pretest_MDF[1].pdf	Supplementary Document	Uploaded 2013-11-06	Available
Attachment_5_-_Data_collection_instrument_-_Adult_questionnaire_Followup_MDF[1].pdf	Supplementary Document	Uploaded 2013-11-06	Available
Attachment_3_-_Data_collection_instrument_-_Adult_questionnaire_Posttest_MDF[1].pdf	Supplementary Document	Uploaded 2013-11-06	Available
Attachment_1_-_Data_collection_instrument_-_Adult_questionnaire_-_Pretest_MDF[1].pdf	Supplementary Document	Uploaded 2013-11-06	Available
SSA.doc	Supporting Statement A	Uploaded 2013-11-06	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
209246	Child Followup- Screenshot	Form	New	Child Followup
209245	Child Posttest -Screenshot	Form	New	Child Posttest
209244	Child Pretest - Screenshot	Form	New	Child Pretest
209243	Adults Programs Usage Log	Form	New	Adults Usage Log
209242	Adult Follow-up - Screenshot	Form	New	Adult Follow-up
209241	Adult Post-test - Screenshot	Form	New	Adult Post-test -Screenshot
209240	Adult Pretest - Screenshot	Form	New	Adult Pretest -Screenshot
209239	Child Assent Form	Form and Instruction	New	Child Assent
209238	Permission and Consent Form	Form and Instruction	New	Consent Form

ICR Details

OMB Control No: 0925-0685	ICR Reference No: 201311-0925-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No: 20779
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: Approved with change	Conclusion Date: 11/21/2013
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/08/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2015	24 Months From Approved
Responses	2,000	0	0
Time Burden (Hours)	1,067	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this project is to evaluate a media literacy substance use prevention intervention, Media Detective Family, for parents and their school-aged children using a randomized controlled trial and establish MDF as an evidence-based intervention. MDF reduces barriers to prevention efforts in rural areas by delivering the intervention on an interactive website or a mobile or wireless devise. MDF focuses on improving children's alcohol and tobacco use knowledge and intentions, and adults' and children's media literacy knowledge and skills. A total of approximately 200 parent-child pairs will be recruited from 6 rural counties in North Carolina and Texas, with 100 pairs randomly assigned to each condition (intervention/control). Information will be collected on knowledge, norms, skills, behavior, behavioral intentions, and demographic characteristics of participating children and adults. Data collection using audio computer-assisted self interviewing will occur at three time points: at pretest, after using MDF or a control computer program for one month, and at 3-month follow-up. 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): 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:
	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
Adult Follow-up - Screenshot	5	Adult Follow-up
Adult Post-test - Screenshot	4	Adult Post-test -Screenshot
Adult Pretest - Screenshot	3	Adult Pretest -Screenshot
Adults Programs Usage Log	6	Adults Usage Log
Child Assent Form	2	Child Assent
Child Followup- Screenshot	12	Child Followup
Child Posttest -Screenshot	11	Child Posttest
Child Pretest - Screenshot	10	Child Pretest
Permission and Consent Form	1	Consent Form

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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	2,000	0	0	2,000	0	0
Annual Time Burden (Hours)	1,067	0	0	1,067	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 information collection.

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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? Yes

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: 11/08/2013

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