Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Youth Health and Climate School Survey	Form	Modified	Available
Att 12 Example Table Shells.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 11 Description of Additional Validity Checks for Study-Developed Questions.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 10 IRB Approval Letter.pdf	Supplementary Document	Uploaded 2017-07-10	Available
Att 9 List of Consultants.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 8 Products from Previous Data Collections.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 7 Teacher Proctor Instructions and Script.docx	Supplementary Document	Uploaded 2017-07-10	Repair queued
Att 6 Letter of Agreement for Participating High Schools.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 5 Detailed Description of Questionnaire Revisions.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 4 Parental_Consent_Form.docx	Supplementary Document	Uploaded 2017-07-10	Available
Attachment 2A Public Comments Received.docx	Supplementary Document	Uploaded 2017-07-10	Available
Att 2 60-day.pdf	Supplementary Document	Uploaded 2017-07-10	Available
Att 1 Legis.pdf	Supplementary Document	Uploaded 2017-07-10	Available
SSB.docx	Supporting Statement B	Uploaded 2017-07-10	Available
SSA.docx	Supporting Statement A	Uploaded 2017-07-10	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212672	Youth Health and Climate School Survey	Form	Modified

ICR Details

OMB Control No: 0920-1035	ICR Reference No: 201707-0920-003
Status: Historical Active	Previous ICR Reference No: 201408-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1035
Title: Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/17/2017
	Date Received in OIRA: 10/04/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2018	12 Months From Approved	11/30/2017
Responses	16,500	0	11,000
Time Burden (Hours)	11,000	0	7,333
Cost Burden (Dollars)	46,695	0	0

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Abstract: CDC requests a one year approval for revision. The information collection uses a self-administered questionnaire, the Youth Health and School Climate Survey, to assess HIV and STD prevention efforts in one local education agency (LEA) funded by CDC Division of Adolescent and School Health. This allows the LEA to identify program strengths and areas that need improvement. Findings allow CDC to determine the impact of recommended strategies and change recommendations if necessary. The questionnaire includes questions on demographics, HIV and STD risk behaviors, use of related health services, school experiences including connectedness, harassment and bullying, homophobia, support of LGBTQ students, receipt of referral for HIV and STD prevention health services, and health education.

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Authorizing Statute(s): US Code: 42 USC 301 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:
	82 FR 17838	04/13/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 46061	10/03/2017
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Youth Health and Climate School Survey	none	Youth Health and School Climate Survey

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ICR Summary of Burden

table that charts list 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	16,500	11,000	0	5,500	0	0
Annual Time Burden (Hours)	11,000	7,333	0	3,667	0	0
Annual Cost Burden (Dollars)	46,695	0	0	46,695	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: Revision includes minor changes to the questionnaire and one additional year of data collection.

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Annual Cost to Federal Government: $215,609

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.     No

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: 10/04/2017

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