DC Public Schools Student Perspectives on Access to Recommended Adolescent Preventive Health Services

Assessments to Inform Program Refinement for HIV, other STD, and Pregnancy Prevention among Middle and High-School Aged Youth

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1235 can be found here:

Documents and Forms

Document Name Document Type
Att 3_Student Focus Group Guide.docx Other-Focus Group Guide
SSA_DCPS_FG.docx Supoprting Statement A IC Document
SSB_DCPS_FG.docx Supporting Statement B IC Document
Att 4_IRB Approval Documentation.PDF IRB Approval IC Document
Att 5_ Parental Consent Form.docx Parental Consent for Minor IC Document
Att 6_ Adult Student Consent Form.docx Adult Student Consent IC Document
Att 7_Youth Student Consent Form.docx Youth Student Consent IC Document
Att 8_Student Verbal Assent.docx Student Verbal Assent IC Document

Information Collection (IC) Details

IC Title:	DC Public Schools Student Perspectives on Access to Recommended Adolescent Preventive Health Services	Agency IC Tracking Number:	092-1235-18AVA

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Focus Group Guide			Att 3_Student Focus Group Guide.docx		Yes	No	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 90	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	90	90
Annual IC Time Burden (Hours)	135	135
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supoprting Statement A	SSA_DCPS_FG.docx	08/13/2018
Supporting Statement B	SSB_DCPS_FG.docx	08/13/2018
IRB Approval	Att 4_IRB Approval Documentation.PDF	08/13/2018
Parental Consent for Minor	Att 5_ Parental Consent Form.docx	08/13/2018
Adult Student Consent	Att 6_ Adult Student Consent Form.docx	08/13/2018
Youth Student Consent	Att 7_Youth Student Consent Form.docx	08/13/2018
Student Verbal Assent	Att 8_Student Verbal Assent.docx	08/13/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.