Understanding Relationship Dynamics and Conflict Survey--Formative Study

Forms and Documents

Document Name	Status
Survey - Incarcerated Respondents Form	New
Survey - MT Respondents Form	New
Screener Form	New
OMB Table 10.25.17.docx Supplementary Document	2017-11-08
OMB BJS question responses 10.25.17.docx Supplementary Document	2017-11-08
Attachment I - authorization from OHRP DHHS.pdf Supplementary Document	2017-11-08
Attachment H NCIPC Research Determination Form.pdf Supplementary Document	2017-03-29
Attachment G - PIA for SRG.pdf Supplementary Document	2017-03-29
Attachment F Consent Forms_072616.docx Supplementary Document	2017-03-29
Attachment C2 - IRB Approval of Changes to Protocol.pdf Supplementary Document	2017-03-29
Attachment C1 - IRB Approval .pdf Supplementary Document	2017-03-29
Attachment C - IRB Application Full Protocol.doc Supplementary Document	2017-03-29
Attachment B2 Responses to Public Comment.pdf Supplementary Document	2017-03-29
Attachment B1 Public Comment.pdf Supplementary Document	2017-03-29
Attachment B - 60 Day FRN.pdf Supplementary Document	2017-03-29
Attachment A-Authorizing Legislation.doc Supplementary Document	2017-03-29
SSB_17FB_11.8.17.docx Supporting Statement B	2017-11-08
SSA_17FB_11.8.17.docx Supporting Statement A	2017-11-08

IC Document Collections

IC ID	Document Title	Status
226225	Survey - Incarcerated Respondents Form	New
226224	Survey - MT Respondents Form	New
226223	Screener Form	New

ICR Details

OMB Control No: 0920-1206	ICR Reference No: 201703-0920-015
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 17FB
Title: Understanding Relationship Dynamics and Conflict Survey--Formative Study
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: 11/17/2017
	Date Received in OIRA: 04/20/2017
Terms of Clearance: Approved consistent with the understanding that HHS/CDC will consult with the HHS or CDC Privacy Program/Office and clarify the applicability of its privacy responsibilities, described in OMB circular A-130 and 5 USC §552a(e)(3), to this information collection. CDC will document the reasons it has determined that a Privacy Act system records notice, Privacy Act statement, and privacy impact assessment are or are not required, and submit such documentation as deemed necessary to OMB as a change request within 6 months of the date of approval for the current ICR.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	24 Months From Approved
Responses	5,405	0	0
Time Burden (Hours)	1,322	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is an exploratory study to gather data from a diverse and targeted convenience sample to better understand factors or groups of factors that may influence violence perpetration that occurs within adult intimate partner relationships. The study is the first component of a larger research agenda that will and is intended to inform the next phase identifying latent classes of intimate partner violence (IPV) perpetrators. For this exploratory study, the focus is gathering extensive data from the diverse convenience sample across multiple domains (e.g., attitudes, perceptions, personal experiences, victimization, etc.) identified by IPV experts and the peer reviewed literature as correlating to IPV perpetration. The information collected in this study is not intended to be generalizable to the population. Rather, these data are intended to inform future research with additional populations and more rigorous sampling strategies.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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 87037	12/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 18649	04/20/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Screener	none	Screener
Survey - MT Respondents	none	Survey
Survey - Incarcerated Respondents	none	Survey

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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	5,405	0	0	5,405	0	0
Annual Time Burden (Hours)	1,322	0	0	1,322	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.

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Annual Cost to Federal Government: $110,420

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 04/20/2017

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