Promoting Adolescent Health through School-based HIV/STD Prevention

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
NGO ESHE Measures	Form	Modified	Available
NGO SSE Measures	Form	Modified	Available
NGO - Screenshots	Form	Modified	Available
NGO SHS Measures	Form	Modified	Available
LEA ESHE Measures	Form	Modified	Available
LEA SHS Measures	Form	Modified	Available
LEA - Screenshots	Form	Modified	Available
LEA SSE Measures	Form	Modified	Available
SEA ESHE Measures	Form	Modified	Available
SEA SHS Measures	Form	Modified	Available
SEA - Screenshots	Form	Modified	Available
SEA SSE Measures	Form	Modified	Available
Att 11 Eval Framework.pdf	Supplementary Document	Uploaded 2017-10-17	Available
Att 10 Analysis of Alternatives.doc	Supplementary Document	Uploaded 2017-10-17	Available
Att 7 Funded Agencies Providing Feedback.docx	Supplementary Document	Uploaded 2017-10-17	Available
Att 6 List of Funded Agencies.docx	Supplementary Document	Uploaded 2017-10-17	Available
Supporting Statement A 17OCT2017.docx	Supporting Statement A	Uploaded 2017-10-17	Available
Att 2 60 FRN.pdf	Supplementary Document	Uploaded 2017-10-17	Available
Att 1 Public Health Service Act Legislation.pdf	Supplementary Document	Uploaded 2017-10-17	Available
Att 9c SSE Rationale.pdf	Supplementary Document	Uploaded 2014-09-04	Available
Att 9b SHS Rationale.pdf	Supplementary Document	Uploaded 2014-09-04	Available
Att 9a ESHE Rationale.pdf	Supplementary Document	Uploaded 2014-09-04	Available
Supporting Statement B 17OCT2017.docx	Supporting Statement B	Uploaded 2017-10-17	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
212973	NGO Exemplary Sexual Health Education Measures	Form	Modified	NGO ESHE Measures
212972	NGO Safe and Supportive Environment Measures	Form	Modified	NGO SSE Measures
212971	NGO Sexual Health Services Measures	Form	Modified	NGO - Screenshots
212971	NGO Sexual Health Services Measures	Form	Modified	NGO SHS Measures
212970	Local Education Agency Exemplary Sexual Health Education Measures	Form	Modified	LEA ESHE Measures
212969	Local Education Agency Sexual Health Services Measures	Form	Modified	LEA SHS Measures
212968	Local Education Agency Safe and Supportive Environment Measures	Form	Modified	LEA - Screenshots
212968	Local Education Agency Safe and Supportive Environment Measures	Form	Modified	LEA SSE Measures
212967	State Education Agency Exemplary Sexual Health Education Measures	Form	Modified	SEA ESHE Measures
212966	State Education Agency Sexual Health Services Measures	Form	Modified	SEA SHS Measures
212965	State Education Agency Safe and Supportive Environment Measures	Form	Modified	SEA - Screenshots
212965	State Education Agency Safe and Supportive Environment Measures	Form	Modified	SEA SSE Measures

ICR Details

OMB Control No: 0920-1049	ICR Reference No: 201710-0920-008
Status: Historical Active	Previous ICR Reference No: 201409-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1049
Title: Promoting Adolescent Health through School-based HIV/STD Prevention
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/16/2018
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/24/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	12 Months From Approved	02/28/2018
Responses	222	0	228
Time Burden (Hours)	804	0	820
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this request is to obtain a one-year extension for data collection using a Web-based program evaluation and monitoring system that will use Web-based questionnaires to organize, plan, and track PS13-1308 funded agency activities conducted to meet the performance and process measures established by the Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent and School Health, (DASH). The system will provide access to data and reports for DASH and its funded agencies (state and local education agencies and non-governmental organizations), which allows areas for improvement to be identified and addressed efficiently. These questionnaires will include performance and process measures to be used for program monitoring, evaluation, and quality improvement for HIV/STD prevention activities.

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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:
	82 FR 16833	04/06/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 48814	10/20/2017
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
Local Education Agency Exemplary Sexual Health Education Measures	NA	LEA ESHE Measures
Local Education Agency Safe and Supportive Environment Measures	NA, NA	LEA SSE Measures ,   LEA - Screenshots
Local Education Agency Sexual Health Services Measures	NA	LEA SHS Measures
NGO Exemplary Sexual Health Education Measures	NA	NGO ESHE Measures
NGO Safe and Supportive Environment Measures	NA	NGO SSE Measures
NGO Sexual Health Services Measures	NA, NA	NGO SHS Measures ,   NGO - Screenshots
State Education Agency Exemplary Sexual Health Education Measures	NA	SEA ESHE Measures
State Education Agency Safe and Supportive Environment Measures	NA, NA	SEA SSE Measures ,   SEA - Screenshots
State Education Agency Sexual Health Services Measures	NA	SEA SHS Measures

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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	222	228	0	-6	0	0
Annual Time Burden (Hours)	804	820	0	-16	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Submission of 0920-1049 is an Extension ICR. Decrease in Burden Hours is due to State Education Agencies dropping out of the previously approved information collection process.

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Annual Cost to Federal Government: $498,851

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: 10/24/2017

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