EVALUATION OF THE PRESIDENTIAL YOUTH FITNESS PROGRAM

Forms and Documents

Document Name	Status
School Administrator Survey - Non-PYFP School Form and Instruction	New
PE Teacher Survey - Non-PYFP Schools Form and Instruction	New
Student Survey - 6th Grade Students in Non-PYFP Schools Form and Instruction	New
Accelerometry Log - 6th Grade Students in Non-PYFP School Form and Instruction	New
FitnessGram Data Collection Form - 6th Grade Students in Non-PYFP School Form and Instruction	New
Parent Focus Group Moderator Form and Instruction	New
PYFP Cost Worksheet Form and Instruction	New
School Administrator Survey (PYFP School) Form and Instruction	New
PFYP Time Use Worksheet Form and Instruction	New
PE Teacher Focus Group Moderator Guide - PYFP School Form and Instruction	New
PE Teacher Survey - PYFP Schools Form and Instruction	New
Student Focus Group Moderator Guide - 6th Grade Students PYFP Schools Form and Instruction	New
Student Survey - 6th Grade Students PYFP Schools Form and Instruction	New
Accelerometry Log - 6th Grade Students PYFP Schools Form and Instruction	New
FitnessGram Data Collection Form - 6th Grade Students PYFP Schools Form and Instruction	New
Att 32 Accelerometry Data Collection - Instructions for PE Teachers.docx Supplementary Document	2017-02-10
PYFP Supporting Statement A 09FEB2017.docx Supporting Statement A	2017-02-09
PYFP Supporting Statement B 09FEB2017.docx Supporting Statement B	2017-02-09
Att 42 PYFP Evaluation Question and Instrument Crosswalk.docx Supplementary Document	2016-12-05
Att 41 Student Focus Group Assent.docx Supplementary Document	2017-02-10
Att 40 Student Accelerometry Assent.docx Supplementary Document	2017-02-10
Att 39 Parent Focus Group Consent.docx Supplementary Document	2017-02-10
Att 38 PE Teacher Focus Group Consent Form.docx Supplementary Document	2017-02-10
Att 37 School Administrator Survey Consent - Online Survey.docx Supplementary Document	2017-02-10
Att 36 PE Teacher Survey Consent.docx Supplementary Document	2017-02-10
Att 34 Accelerometry School Liaison Data Collection Checklist.docx Supplementary Document	2016-12-05
Att 33 Accelerometry Belt Instructions.docx Supplementary Document	2017-02-10
Att 29 Pacer Test Individual Score Sheet.docx Supplementary Document	2016-12-02
Att 27 FitnessGram Data Collection Protocol.docx Supplementary Document	2016-12-02
Att 18 School Administrator Invitation to Participate in Survey.docx Supplementary Document	2017-02-10
Att 17 Physical Education (PE) Teacher Invitation to Participate in PYFP Evaluation Activities.docx Supplementary Document	2017-02-10
Att 16b Parent Letter - Active Consent Survey and Fitness Assessments (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 16a Parent Letter - Active Consent Survey and Fitness Assessment (PYFP Schools).docx Supplementary Document	2017-02-10
Att 15 Parent Accelerometer Consent Form.docx Supplementary Document	2017-02-10
Att 14 Focus Group Parent Consent and Interest Form (PYFP Schools).docx Supplementary Document	2017-02-10
Att 13b Parent Letter - Passive Consent Survey and Fitness Assessments (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 13a Parent Letter - Passive Consent Survey and Fitness Assessment (PYFP Schools).docx Supplementary Document	2017-02-10
Att 12b School Liaison Recruitment Call Script (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 12a School Liaison Recruitment Call Script (PYFP Schools).docx Supplementary Document	2017-02-10
Att 11b School Liaison Recruitment Letter (non-PYFP).docx Supplementary Document	2017-02-10
Att 11a School Liaison Recruitment Letter (PYFP).docx Supplementary Document	2017-02-10
Att 10b Principal Recruitment Call Script (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 10a Principal Recruitment Call Script (PYFP).docx Supplementary Document	2017-02-10
Att 9b Superintendent Recruitment Call Script 2016 (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 9a Superintendent Recruitment Call Script (PYFP Schools).docx Supplementary Document	2017-02-10
Att 8 Presidential Youth Fitness Program Evaluation Q&A.docx Supplementary Document	2017-02-10
Att 7b PYFP Evaluation Overview and Acknowledgement Form (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 7a PYFP Evaluation Overview and Acknowledgement Form (PYFP Schools).docx Supplementary Document	2017-02-10
Att 6b Principal School Recruitment Letter (non-PYFP).docx Supplementary Document	2017-02-10
Att 6a Principal School Recruitment Letter (PYFP).docx Supplementary Document	2017-02-10
Att 5b Superintendent School Recruitment Letter (non-PYFP Schools).docx Supplementary Document	2017-02-10
Att 5a Superintendent School Recruitment Letter (PYFP Schools).docx Supplementary Document	2017-02-10
Att 35 ICF Institutional Review Board Approval Memorandum.pdf Supplementary Document	2016-11-29
Att 43 Summary of the Literature Informing Power Analyses.docx Supplementary Document	2016-11-29
Att 4 Summary of Data Collection Activities by School Type.docx Supplementary Document	2016-11-29
Att 3b PYFP Funding FAQ.PDF Supplementary Document	2016-11-29
Att 3a PYFP Round of Funding Timeline.docx Supplementary Document	2016-11-29
Att 2b 60-Day FRN Response to Comments.docx Supplementary Document	2016-11-29
Att 2a 60-day Federal Register Notice.pdf Supplementary Document	2016-11-29
Att 1 Authorizing Legislation.doc Supplementary Document	2016-11-29

IC Document Collections

IC ID	Document Title	Status
224685	School Administrator Survey - Non-PYFP School Form and Instruction	New
224684	PE Teacher Survey - Non-PYFP Schools Form and Instruction	New
224683	Student Survey - 6th Grade Students in Non-PYFP Schools Form and Instruction	New
224682	Accelerometry Log - 6th Grade Students in Non-PYFP School Form and Instruction	New
224671	FitnessGram Data Collection Form - 6th Grade Students in Non-PYFP School Form and Instruction	New
224668	Parent Focus Group Moderator Form and Instruction	New
224667	PYFP Cost Worksheet Form and Instruction	New
224666	School Administrator Survey (PYFP School) Form and Instruction	New
224663	PFYP Time Use Worksheet Form and Instruction	New
224662	PE Teacher Focus Group Moderator Guide - PYFP School Form and Instruction	New
224660	PE Teacher Survey - PYFP Schools Form and Instruction	New
224644	Student Focus Group Moderator Guide - 6th Grade Students PYFP Schools Form and Instruction	New
224643	Student Survey - 6th Grade Students PYFP Schools Form and Instruction	New
224642	Accelerometry Log - 6th Grade Students PYFP Schools Form and Instruction	New
224641	FitnessGram Data Collection Form - 6th Grade Students PYFP Schools Form and Instruction	New

ICR Details

OMB Control No: 0920-1167	ICR Reference No: 201611-0920-009
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-16AQM
Title: EVALUATION OF THE PRESIDENTIAL YOUTH FITNESS PROGRAM
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: 02/28/2017
	Date Received in OIRA: 12/22/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	24 Months From Approved
Responses	4,330	0	0
Time Burden (Hours)	1,275	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC seeks approval to conduct the Presidential Youth Fitness Program (PYFP), School Administrator survey. This study is administered in schools to evaluate the impact of the PYFP on PE teacher, student and school-level outcomes, as well as barriers and facilitators to program implementation. Results will be used to (1) inform stakeholders about whether PE teacher, student and school-level outcomes differ among schools implementing the PYFP versus those offering a traditional physical education course and (2) provide information that will be used for program improvement.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. Public Health Service 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:
	81 FR 38705	06/14/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 86330	11/30/2016
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 15

IC Title	Form No.	Form Name
FitnessGram Data Collection Form - 6th Grade Students PYFP Schools	NA	Fitness Gram Data Collection Form - 6th Grade Students in PYFP Schools
Student Focus Group Moderator Guide - 6th Grade Students PYFP Schools	NA	Student Focus Group Moderator Guide - 6th Grade Student in PYFP School
PYFP Cost Worksheet	NA	Cost Questionnaire - School Administrators in PYFP School
Accelerometry Log - 6th Grade Students in Non-PYFP School	NA	Accelerometry Log - 6th Grade Students in Non-PYFP Schools
Student Survey - 6th Grade Students in Non-PYFP Schools	NA	Student Survey - 6th Grade Students in Non-PYFP Schools
PE Teacher Survey - Non-PYFP Schools	NA	PE Teacher Survey - Non-PYFP School
School Administrator Survey - Non-PYFP School	NA	School Administrator Survey - Non-PYFP School
PE Teacher Survey - PYFP Schools	NA	PE Teacher Survey - PE Teacher in PYFP School
PE Teacher Focus Group Moderator Guide - PYFP School	NA	PE Teacher Focus Group Moderator Guide - PE Teacher in PYFP School
PFYP Time Use Worksheet	NA	PYFP Time Use Information Sheet - PE Teacher in PYFP School
School Administrator Survey (PYFP School)	NA	School Administrator Survey - School Administrator in PYFP School
Parent Focus Group Moderator	NA	Parent Focus Group Moderator Guide - Parent of 6th Grade Student at PYFP School
FitnessGram Data Collection Form - 6th Grade Students in Non-PYFP School	NA	FitnessGram Data Collection Form - 6th Grade Students in Non-PYFP School
Accelerometry Log - 6th Grade Students PYFP Schools	NA	Accelerometry Log - 6th Grade Students in PYFP Schools
Student Survey - 6th Grade Students PYFP Schools	NA	Student Survey - 6th Grade Students in PYFP Schools

---

ICR Summary 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	4,330	0	0	4,330	0	0
Annual Time Burden (Hours)	1,275	0	0	1,275	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: Submission of 0920-16AQM is a New ICR.

---

Annual Cost to Federal Government: $540,560

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: 12/22/2016

---