Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Youth Health and Climate School Survey	Form	New	Available
Att 11 Description of Additional Validity Checks for Study-Developed Questions.docx	Supplementary Document	Uploaded 2014-11-05	Available
Att 10 Teacher Proctor Instructions and Script.docx	Supplementary Document	Uploaded 2014-11-05	Available
Att 9 Letter of Agreement for Participating High Schools.docx	Supplementary Document	Uploaded 2014-11-05	Available
Att 7 Example Table Shells.docx	Supplementary Document	Uploaded 2014-08-14	Available
Att 6 IRB Approval 2014-08-11.docx	Supplementary Document	Uploaded 2014-08-14	Available
Att 5 List of Consultants.docx	Supplementary Document	Uploaded 2014-08-14	Available
Att 4 Passive_Parental_Consent_Form_with_Translations.docx	Supplementary Document	Uploaded 2014-11-05	Available
Att 8 Public Comments on 60-day FRN.pdf	Supplementary Document	Uploaded 2014-08-14	Available
Att 2 60 Day FRN.pdf	Supplementary Document	Uploaded 2014-08-14	Available
Att 1 Legis.pdf	Supplementary Document	Uploaded 2014-08-14	Available
SSB 2014-11-04_clean.docx	Supporting Statement B	Uploaded 2014-11-05	Available
SSA_2014-11-04_clean.docx	Supporting Statement A	Uploaded 2014-11-05	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212672	Youth Health and Climate School Survey	Form	New

ICR Details

OMB Control No: 0920-1035	ICR Reference No: 201408-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 14YI
Title: Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency
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: 11/07/2014
	Date Received in OIRA: 09/12/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2017	36 Months From Approved
Responses	11,000	0	0
Time Burden (Hours)	7,333	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection uses a self-administered paper-pencil questionnaire, the Youth Health and School Climate Survey, to assess HIV and STD prevention efforts in one local education agency (LEA) funded by CDC Division of Adolescent and School Health under cooperative agreement PS13-1308. This will allow the LEA to identify program strengths and areas that need improvement. Findings will allow CDC to determine the impact of currently recommended strategies and change recommendations if necessary. The questionnaire includes questions on demographics, HIV and STD risk behaviors, use of related health services, school experiences including connectedness, harassment and bullying, homophobia, support of LGBTQ students, receipt of referral for HIV and STD prevention health services, and health education.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: PHSA
  

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:
	79 FR 27615	05/14/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 50651	08/25/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Youth Health and Climate School Survey	none	Youth Health and Climate School 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	11,000	0	0	11,000	0	0
Annual Time Burden (Hours)	7,333	0	0	7,333	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.

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Annual Cost to Federal Government: $299,130

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: 09/12/2014

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