Request for Approval

Request for Approval under the “Generic Clearance for the Collection of Routine Customer Feedback” (OMB Control Number: 0920-1050)

TITLE OF INFORMATION COLLECTION: Technical Packages for Violence Prevention: Using Evidence-based Strategies in Your Violence Prevention Efforts Online Survey

PURPOSE:

A technical package (TP) is a compilation of a core group of strategies to achieve and sustain substantial reductions in a specific risk factor or health outcome. It is valuable because it allows communities to prioritize interventions based on the best available evidence and avoid a scattershot approach to prevention. The Division of Violence Prevention (DVP) has disseminated three TPs related to child abuse and neglect, sexual violence, and youth violence and plans to release two additional TPs (suicide and intimate partner violence) in 2017. It is important to monitor the uptake and influence of these TPs on public health practice once they are released.

The purpose of this survey is to obtain additional information on user organization, violence focus area, and intent on using the technical packages. The information collected will be used to help DVP monitor the uptake of the technical packages to improve public health practice for violence prevention.

Information gathered will be used only internally for general service improvement and is not intended for release outside of the agency. Information gathered will not be used for the purpose of substantially informing influential policy decisions. Without these types of feedback, the Agency will not have timely information to adjust its services to meet customer needs.

DESCRIPTION OF RESPONDENTS:

The technical packages are designed for anyone working to prevent violence in their communities, including practitioners, researchers, and grantees. Respondents will include individuals that are interested in using the best available evidence to prevent multiple forms of violence.

TYPE OF COLLECTION: (Check one)

[ ] Customer Comment Card/Complaint Form [ X] Customer Satisfaction Survey

[ ] Usability Testing (e.g., Website or Software [ ] Small Discussion Group

[ ] Focus Group [ ] Other: ______________________

CERTIFICATION:

I certify the following to be true:

1. The collection is voluntary.

2. The collection is low-burden for respondents and low-cost for the Federal Government.

3. The collection is non-controversial and does not raise issues of concern to other federal agencies.

4. The results are not intended to be disseminated to the public.

5. Information gathered will not be used for the purpose of substantially informing influential policy decisions.

6. The collection is targeted to the solicitation of opinions from respondents who have experience with the program or may have experience with the program in the future.

Name:____________Karen Angel____________________________________

To assist review, please provide answers to the following question:

Personally Identifiable Information:

1. Is personally identifiable information (PII) collected? [ ] Yes [ X] No

2. If Yes, is the information that will be collected included in records that are subject to the Privacy Act of 1974? [ ] Yes [ X ] No

3. If Applicable, has a System or Records Notice been published? [ ] Yes [X ] No

Gifts or Payments:

Is an incentive (e.g., money or reimbursement of expenses, token of appreciation) provided to participants? [ ] Yes [ X] No

BURDEN HOURS

Category of Respondent	Form Name	No. of Respondents	Participation Time (Hours)	Burden (Hours)
Pop-up box with web page users	Instrument DVP TP (Att. A)	861	5/60	72
Totals		861		72

FEDERAL COST: The estimated annual cost to the Federal government is $297___

If you are conducting a focus group, survey, or plan to employ statistical methods, please provide answers to the following questions:

The selection of your targeted respondents

1. Do you have a customer list or something similar that defines the universe of potential respondents and do you have a sampling plan for selecting from this universe? [ ] Yes [ X] No

If the answer is yes, please provide a description of both below (or attach the sampling plan)? If the answer is no, please provide a description of how you plan to identify your potential group of respondents and how you will select them?

A pop-up box will appear when the user tries to download one of the technical packages for violence prevention (http://www.cdc.gov/violenceprevention/pub/technical-packages.html). Users will be asked to complete the voluntary brief survey (Att. A and B) before they download one of the technical packages. If they choose not to complete the survey, they can click “no thanks” and still download the technical package.

Administration of the Instrument

1. How will you collect the information? (Check all that apply)

[ X ] Web-based or other forms of Social Media

[ ] Telephone

[ ] In-person

[ ] Mail

[ ] Other, Explain

2. Will interviewers or facilitators be used? [ ] Yes [ X] No

3