Monitoring and Reporting System for Rape Prevention and Education (RPE) Program Awardees

Forms and Documents

Document Name	Status
Program Report Tool - Annual Reporting Form	Unchanged
Work Plan Tool - Annual Reporting Form	Unchanged
Program Report Tool - Initial Population Form	Modified
Work Plan Tool - Initial Population Form	Modified
Crosswalk of Changes_OMB_No.0920-1130.DOCX Supplementary Document	2017-03-27
Change_Request_OMB_No.0920-1130.docx Justification for No Material/Nonsubstantive Change	2017-03-27
Att._5_ IRB-Determination.pdf Supplementary Document	2016-05-19
Att._2_60-day_FRN_v80_no228.pdf Supplementary Document	2016-05-19
Att._1c_Legislation_Violence_against_Women_Act.pdf Supplementary Document	2016-05-19
Att._1b_Legislation_Public_Health_Service_Act_280b.pdf Supplementary Document	2016-05-19
Att._1a_Legislation_Public_Health_Service_Act_247b.pdf Supplementary Document	2016-05-19
SSB_MRS_RPE_30Day_041416.docx Supporting Statement B	2016-05-19
SSA_16BX_30D_ICRO_051616.docx Supporting Statement A	2016-05-19

IC Document Collections

IC ID	Document Title	Status
221590	Program Report Tool - Annual Reporting Form	Unchanged
221589	Work Plan Tool - Annual Reporting Form	Unchanged
221588	Program Report Tool - Initial Population Form	Modified
221587	Work Plan Tool - Initial Population Form	Modified

ICR Details

OMB Control No: 0920-1130	ICR Reference No: 201703-0920-012
Status: Historical Active	Previous ICR Reference No: 201605-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 17AAX
Title: Monitoring and Reporting System for Rape Prevention and Education (RPE) Program Awardees
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/30/2017
	Date Received in OIRA: 03/29/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2019	08/31/2019	08/31/2019
Responses	146	0	146
Time Burden (Hours)	654	0	654
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC seeks to collect information from Rape Prevention and Education (RPE) Program awardees related to the implementation, performance and monitoring of the programs per a cooperative agreement.

---

Authorizing Statute(s): US Code: 42 USC 247 Name of Law: PHSA
   US Code: 42 USC 13925 Name of Law: Violence Against Women Act
   US Code: 42 USC 280 Name of Law: PHSA
  

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:
	80 FR 74108	11/27/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 32329	05/23/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Work Plan Tool - Initial Population	WPT, none	Rape Prevention and Education Work Plan Tool ,   (Updated) Work Plan Tool
Program Report Tool - Initial Population	PRT, none	Rape Prevention and Education Program Report Tool ,   (Updated) Program Report Tool
Program Report Tool - Annual Reporting	none	Rape Prevention and Education Program Report Tool
Work Plan Tool - Annual Reporting	none	Rape Prevention and Education Work PlanTool

---

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	146	146	0	0	0	0
Annual Time Burden (Hours)	654	654	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

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: $84,200

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: 03/29/2017

---