SMARTool Pilot Replication Project

Forms and Documents

Document Name	Status
Form 10 Process evaluation participant survey Form and Instruction	New
Form 9 Key Informant Interviews Form and Instruction	New
Form 8 Student Rosters and Administrative Data Form Form and Instruction	New
Form 7 Attendance Form Form and Instruction	New
Form 6 Facilitator Survey Form and Instruction	New
Form 5 Facilitator Session Log Form and Instruction	New
Form 4 Outcome Evaluation Follow-Up Survey Form and Instruction	New
Form 3 Outcome Evaluation Baseline Survey Form and Instruction	New
Form 2 Youth Assent Form Form and Instruction	New
Form 1 Parental consent Form and Instruction	New
Supporting Statement B_6.11.19.docx Supporting Statement B	2019-06-17
Supporting Statement A_6.11.19(final).docx Supporting Statement A	2019-06-18
IRB Not Human Research Determination_11.27.18.pdf Supplementary Document	2018-12-17
Appendix N. 60–Day Federal Register Notice.pdf Supplementary Document	2018-11-14

IC Document Collections

IC ID	Document Title	Status
233499	Process evaluation participant survey Form and Instruction	New
233498	Key Informant Interviews Form and Instruction	New
233493	Student Rosters and Administrative Data Form Form and Instruction	New
233492	Attendance Form Form and Instruction	New
233491	Facilitator Survey Form and Instruction	New
233490	Facilitator Session Log Form and Instruction	New
233237	Outcome Evaluation Follow-Up Survey Form and Instruction	New
233236	Outcome Evaluation Baseline Survey Form and Instruction	New
233235	Youth Assent Form Form and Instruction	New
233216	Parental consent Form and Instruction	New

ICR Details

OMB Control No: 0937-0207	ICR Reference No: 201809-0937-001
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/OASH	Agency Tracking No:
Title: SMARTool Pilot Replication Project
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 06/19/2019
	Date Received in OIRA: 02/08/2019
Terms of Clearance: This ICR is approved consistent with the understanding that, due to the sensitive nature of the questions being answered by the students, the identity (name/address/location) of the schools will not be disclosed; participating schools will not receive school or classroom-level data; and publicly available results will be aggregated across classrooms and schools consistent with the statistical design in Supporting Statement Part B.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2022	36 Months From Approved
Responses	8,540	0	0
Time Burden (Hours)	2,243	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS), is requesting approval by OMB of a new information collection request. OASH is updating the Center for Relationship Education's Systematic Method for Assessing Risk-Avoidance Tool (SMARTool), a tool for sexual risk avoidance (SRA) curriculum developers and implementing organizations (IOs) to ensure that their SRA curricula are grounded in evidence. In an effort to assess the SMARTool's impact, OASH aims to conduct a formative evaluation to (1) provide preliminary evidence on the effectiveness of SRA curricula that are aligned with the SMARTool, (2) derive lessons learned to improve the implementation of SRA curricula, and (3) develop and test baseline and follow-up questionnaires that assess SRA program effects on the key SMARTool constructs. The evaluation will be conducted with an estimated four IOs. The evaluation will use quantitative and qualitative methods and will include both a process evaluation and an outcome evaluation.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service 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:
	83 FR 30942	07/02/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 2884	02/08/2019
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 10

IC Title	Form No.	Form Name
Parental consent	1, 1	Parental Conset Form
Key Informant Interviews	9	Process Evaluation Key Informant Interviews
Process evaluation participant survey	10	Process Evaluation Participant Survey
Facilitator Session Log	5	Process Eval Facilitator Session Log
Attendance Form	7	Attendance Form
Student Rosters and Administrative Data Form	8	Classroom Report Report
Youth Assent Form	2	Youth Assent Form
Outcome Evaluation Baseline Survey	3	Outcome Baseline Student Survey
Outcome Evaluation Follow-Up Survey	4	Follow-up student survey
Facilitator Survey	6	Process Evaluation Facilitator Survey

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ICR Summary 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	8,540	0	0	8,540	0	0
Annual Time Burden (Hours)	2,243	0	0	2,243	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: New collection

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Annual Cost to Federal Government: $2,366,667

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.     Yes

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: 02/08/2019

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