Responding to Intimate Violence in Relationship Programs (RIViR)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
RIViR_OMB_Refs_Nov_2_2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_E.1_IRB Approval Notice.pdf	Supplementary Document	Uploaded 2016-11-09	Available
Att_D.1_Existing validated IPV and TDV screening tools_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_B.8_Youth over 18_consent_script_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_B.7_Youth over 18_consent_form_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_B.6_Youth_assent_script_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Repair queued
Att_B.5_Youth_assent_form_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_B.4_Parent permission_script_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Repair queued
Att_B.3_Parent permission_form_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Repair queued
Att_B.2_Adult_consent_script_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_B.1_Adult_consent_form_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
Att_A.3_Recruitment script for youth 18+_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Repair queued
Att_A.2_Recruitment script for adults_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Repair queued
Att_A.1_Lead letter for parents_Oct 10 2016.docx	Supplementary Document	Uploaded 2016-11-09	Available
RIViR_OMB_SSB_Oct 10 2016.doc	Supporting Statement B	Uploaded 2016-11-09	Available
RIViR_OMB_SSA_Nov 3 2016_final.docx	Supporting Statement A	Uploaded 2016-11-09	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
224373	Administration of data collection protocol and record-keeping	Other-Staff involvement in data collection	New
224372	Participant recruitment	Other-Recruitment Efforts	New
224371	Post screener questions for youth (C.3)	Other-Post Screener Questions	New
224370	Post screener questions for adults (C.3)	Other-Post Screener Questions	New
224369	Contact information form for parents of youth younger than 18 (C.2)	Other-Contact Info	New
224368	Locator section for adults (C.1)	Other-Location section	New
224367	2.3: TDV Screener 3	Other-Screener	New
224366	2.2: TDV Screener 2	Other-Screener	New
224365	2.1: TDV Screener 1	Other-Screener	New
224364	1.3: IPV Screener 3	Other-Screener	New
224363	1.2: IPV Screener 2	Other-Screener	New
224362	1.1: IPV Screener 1	Other-Screener	New

ICR Details

OMB Control No: 0970-0503	ICR Reference No: 201611-0970-002
Status: Historical Inactive	Previous ICR Reference No:
Agency/Subagency: HHS/ACF	Agency Tracking No:
Title: Responding to Intimate Violence in Relationship Programs (RIViR)
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: Withdrawn	Conclusion Date: 06/28/2017
	Date Received in OIRA: 11/14/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		24 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval for data collection as a component of the Responding to Intimate Violence in Relationship Programs (RIVIR) project. The goals of this research project are to develop improved theoretical frameworks, screening tools, and surrounding protocols for recognizing and addressing intimate partner violence (IPV) and teen dating violence (TDV) in healthy marriage and relationship education (HMRE) programs with the diverse, middle- to low-income populations they serve. We are studying HMRE programs, and we are referring to them as “healthy relationship” (HR) programs in this project (and consequently throughout this document). This project has already conducted several activities using existing data sources and materials to synthesize information about the current state of the field and to identify potential IPV and TDV screeners and protocols. The project is now planning to test these IPV and TDV screeners and surrounding protocols in HR programs. This Information Collection Request seeks approval for this testing component of the RIVIR project. We plan to test standardized quantitative tools, as well as open-ended scripts that create opportunities for disclosure of IPV or TDV among adults and youth who participate in HR programs. This work will include data collection from approximately 1,200 HR program participants and will be completed in collaboration with approximately four HR grantee organizations funded by ACF’s Office of Family Assistance (OFA) to implement HR programs.

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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:
	81 FR 21553	04/12/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 78835	11/09/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
1.1: IPV Screener 1
1.2: IPV Screener 2
1.3: IPV Screener 3
2.1: TDV Screener 1
2.2: TDV Screener 2
2.3: TDV Screener 3
Locator section for adults (C.1)
Contact information form for parents of youth younger than 18 (C.2)
Post screener questions for adults (C.3)
Post screener questions for youth (C.3)
Participant recruitment
Administration of data collection protocol and record-keeping

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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 data collection.

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Annual Cost to Federal Government: $430,000

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: 11/14/2016

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