Understanding Relationship Dynamics and Conflict Survey--Formative Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Survey - Incarcerated Respondents	Form	Unchanged	Available
Survey - MT Respondents	Form	Unchanged	Available
Screener	Form	Unchanged	Available
OMB# 0920-1206 Change Request 3.29.2018.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2018-03-29	Available
Att 2. Privacy Determination.pdf	Supplementary Document	Uploaded 2018-03-28	Available
OMB Table 10.25.17.docx	Supplementary Document	Uploaded 2017-11-08	Available
OMB BJS question responses 10.25.17.docx	Supplementary Document	Uploaded 2017-11-08	Available
Attachment I - authorization from OHRP DHHS.pdf	Supplementary Document	Uploaded 2017-11-08	Available
Attachment H NCIPC Research Determination Form.pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment G - PIA for SRG.pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment F Consent Forms_072616.docx	Supplementary Document	Uploaded 2017-03-29	Available
Attachment C2 - IRB Approval of Changes to Protocol.pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment C1 - IRB Approval .pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment C - IRB Application Full Protocol.doc	Supplementary Document	Uploaded 2017-03-29	Available
Attachment B2 Responses to Public Comment.pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment B1 Public Comment.pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment B - 60 Day FRN.pdf	Supplementary Document	Uploaded 2017-03-29	Available
Attachment A-Authorizing Legislation.doc	Supplementary Document	Uploaded 2017-03-29	Available
SSB_17FB_11.8.17.docx	Supporting Statement B	Uploaded 2017-11-08	Available
SSA_17FB_11.8.17.docx	Supporting Statement A	Uploaded 2017-11-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226225	Survey - Incarcerated Respondents	Form	Unchanged
226224	Survey - MT Respondents	Form	Unchanged
226223	Screener	Form	Unchanged

ICR Details

OMB Control No: 0920-1206	ICR Reference No: 201803-0920-020
Status: Historical Active	Previous ICR Reference No: 201703-0920-015
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1206-18YC
Title: Understanding Relationship Dynamics and Conflict Survey--Formative Study
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: 04/11/2018
	Date Received in OIRA: 03/29/2018
Terms of Clearance:

table that charts list comparision

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

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Abstract: This change request is in response to the terms of agreement for approval. Privacy Act information is included. 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

table that charts list of burden

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

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

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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: 03/29/2018

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