Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
School Climate Index Interview Guide for School Staff	Form	New	Available
School Climate Index Interview Guide for School Level Administrators	Form	New	Available
School Climate Index Interview Guide for District Level Administrators	Form	New	Available
San Francisco Unified School District School Health Climate and Service Assessment Survey	Form	New	Available
Los Angeles Unified School District School Helath Climate and Service Assessment Survey	Form	New	Available
Broward County Public Schools School Health Climate and Service Assessment	Form	New	Available
Att 18-Consent School Climate Interviews.docx	Supplementary Document	Uploaded 2015-01-30	Available
Att 17-Consent_SanFrancisco_2015-01-29clean.docx	Supplementary Document	Uploaded 2015-01-30	Available
Att 16-Consent_LA_2015-01-29clean.docx	Supplementary Document	Uploaded 2015-01-30	Available
Att 15-Consent_Broward County_2015-01-29clean.docx	Supplementary Document	Uploaded 2015-01-30	Available
Att 20-PublicCommentAndResponse.pdf	Supplementary Document	Uploaded 2014-09-10	Available
Att 19-Example Data Analysis Table Shells.docx	Supplementary Document	Uploaded 2014-09-10	Available
Att 14-Contractor IRB Approval-CIIG.pdf	Supplementary Document	Uploaded 2014-09-10	Available
Att 13-Contractor IRB Approval-Screens.pdf	Supplementary Document	Uploaded 2014-09-10	Available
Att 12-Consultants_on_the_IC.docx	Supplementary Document	Uploaded 2014-09-10	Available
Att 2-60 Day FRN.pdf	Supplementary Document	Uploaded 2014-09-10	Available
Att 1-PHS Act Legislation.pdf	Supplementary Document	Uploaded 2014-09-10	Available
SSB.docx	Supporting Statement B	Uploaded 2014-09-10	Repair queued
SSA 0920-14AHH_2014-01-30clean.docx	Supporting Statement A	Uploaded 2015-01-30	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213082	School Staff Interview	Form	New	School Climate Index Interview Guide for School Staff
213081	School Level Administrator Interview	Form	New	School Climate Index Interview Guide for School Level Administrators
213079	District Level Administrator Interview	Form	New	School Climate Index Interview Guide for District Level Administrators
213075	San Francisco Unified School District School Health Climate and Service Assessment Survey	Form	New	San Francisco Unified School District School Health Climate and Service Assessment Survey
213073	Los Angeles Unified School District School Health Climate and Service Assessment Survey	Form	New	Los Angeles Unified School District School Helath Climate and Service Assessment Survey
213072	Broward County School Health Climate and Service Assessment Survey	Form	New	Broward County Public Schools School Health Climate and Service Assessment

ICR Details

OMB Control No: 0920-1048	ICR Reference No: 201409-0920-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-14AHH
Title: Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services
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: 02/03/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/26/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2018	36 Months From Approved
Responses	518	0	0
Time Burden (Hours)	243	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The Centers for Disease Control and Prevention (CDC) requests a 3-year OMB approval to conduct a new information collection entitled, "Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services." The information collection uses 2 separate, but complementary, information collections to conduct assessment of HIV and STD prevention efforts that are taking place in three local education agencies (LEA) funded by the Centers for Disease Control and Prevention (CDC), Division of Adolescent and School Health (DASH) under strategy 4 (School-Centered HIV/STD Prevention for Young Men Who Have Sex with Men (YMSM) of PS13-1308: Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance. This data collection will provide data and reports for the funded LEAs, and will allow the LEAs to identify areas of the program that are working well and other areas that will need additional improvement. In addition, the findings will allow CDC to determine the potential impact of currently recommended strategies and make changes to those recommendations if necessary.

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Services 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:
	79 FR 33924	06/13/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 54723	09/12/2014
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Broward County School Health Climate and Service Assessment Survey	None	Broward County Public Schools School Health Climate and Service Assessment
District Level Administrator Interview	None	School Climate Index Interview Guide for District Level Administrators
Los Angeles Unified School District School Health Climate and Service Assessment Survey	None	Los Angeles Unified School District School Helath Climate and Service Assessment Survey
San Francisco Unified School District School Health Climate and Service Assessment Survey	None	San Francisco Unified School District School Health Climate and Service Assessment Survey
School Level Administrator Interview	None	School Climate Index Interview Guide for School Level Administrators
School Staff Interview	None	School Climate Index Interview Guide for School Staff

---

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	518	0	0	518	0	0
Annual Time Burden (Hours)	243	0	0	243	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.

---

Annual Cost to Federal Government: $58,211

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: 09/26/2014

---