Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
San Francisco Unified School District School Health Climate and Service Assessment Survey	Form	Modified	Available
Los Angeles Unified School District School Health Climate and Service Assessment Survey	Form	Modified	Available
Broward County School Health Climate and Service Assessment Survey	Form	Modified	Available
Att 19-Example Data Analysis Table Shells.docx	Supplementary Document	Uploaded 2018-01-29	Available
Att 18-Consent School Climate Interviews.docx	Supplementary Document	Uploaded 2018-01-29	Available
Att 17-Consent_SanFrancisco.docx	Supplementary Document	Uploaded 2018-01-29	Available
Att 16-Consent_LA.docx	Supplementary Document	Uploaded 2018-01-29	Available
Att 15-Consent_Broward County.docx	Supplementary Document	Uploaded 2018-01-29	Available
Att 14-Contractor IRB Approval-CIIG (UPDATED).pdf	Supplementary Document	Uploaded 2018-01-29	Available
Att 13-Contractor IRB Approval-Screens.pdf	Supplementary Document	Uploaded 2018-01-29	Available
Att 12-Consultants_on_the_IC.docx	Supplementary Document	Uploaded 2018-01-29	Available
Att 2-60-dayFRN.pdf	Supplementary Document	Uploaded 2018-01-29	Available
Att 1-PHS Act Legislation.pdf	Supplementary Document	Uploaded 2018-01-29	Available
SSB.docx	Supporting Statement B	Uploaded 2018-01-29	Available
SSA.docx	Supporting Statement A	Uploaded 2018-01-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213082	School Staff Interview	Other-Interview Guide	Modified
213081	School Level Administrator Interview	Other-Interview Guide	Modified
213079	District Level Administrator Interview	Other-Interview Guide	Modified
213075	San Francisco Unified School District School Health Climate and Service Assessment Survey	Form	Modified
213073	Los Angeles Unified School District School Health Climate and Service Assessment Survey	Form	Modified
213072	Broward County School Health Climate and Service Assessment Survey	Form	Modified

ICR Details

OMB Control No: 0920-1048	ICR Reference No: 201801-0920-007
Status: Historical Active	Previous ICR Reference No: 201409-0920-007
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1048
Title: Assessing Education Agency Staff Perceptions of School Climate and Youth Access to Services
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: 04/09/2018
	Date Received in OIRA: 02/20/2018
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2019	12 Months From Approved	04/30/2018
Responses	779	0	518
Time Burden (Hours)	364	0	243
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests a 1-year OMB approval to conduct the final data collection in a series of data collections. The information collection uses 2 separate, but complementary, information collections to conduct assessment of HIV and STD prevention efforts that are taking place in three local education agencies (LEA) funded by the CDC, Division of Adolescent and School Health (DASH) under strategy 4 (School-Centered HIV/STD Prevention for Young Men Who Have Sex with Men (YMSM) of PS13-1308: Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance. These efforts include strategies to increase student access to key health services and improve the school climate.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Services Act
  

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 39125	08/17/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 7186	02/20/2018
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Los Angeles Unified School District School Health Climate and Service Assessment Survey	none	Los Angeles Schools Assessment
District Level Administrator Interview
School Level Administrator Interview
Broward County School Health Climate and Service Assessment Survey	none	Broward County School Assessment
San Francisco Unified School District School Health Climate and Service Assessment Survey	none	San Francisco Schools Assessment
School Staff Interview

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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	779	518	0	261	0	0
Annual Time Burden (Hours)	364	243	0	121	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: Burden is recalculated for one data collection event over one year; previous approval was for two data collection events over 3 years.

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Annual Cost to Federal Government: $53,812

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: 02/20/2018

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