Federal Evaluation of Making Proud Choices! (MPC!)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
2020-03716_30DayFRN_MPC.pdf	Supplementary Document	Uploaded 2020-02-25	Repair queued
MPC_SS_B_OMB_extension_30Day.docx	Supporting Statement B	Uploaded 2020-02-19	Available
MPC_SS_A_OMB_extension_30Day (3) 2262020.docx	Supporting Statement A	Uploaded 2020-02-26	Available
Attachment F Section 301 Public Health Service Act.docx	Supplementary Document	Uploaded 2020-01-02	Available
Attachment E_Analysis Plan.docx	Supplementary Document	Uploaded 2020-02-19	Available
Attachment D_Confidentiality Pledge.docx	Supplementary Document	Uploaded 2020-01-02	Available
Attachment C_Persons Consulted on Instrument Development and Analysis for the Followup Survey.docx	Supplementary Document	Uploaded 2020-02-19	Available
Attachment B_Sources Referenced for the Followup Survey.docx	Supplementary Document	Uploaded 2020-01-02	Available
Attachment A_Question by Question Source Table for the Followup Survey.docx	Supplementary Document	Uploaded 2020-02-19	Available
Attachment G 2019-27376 60 Day FRN 12192019.pdf	Supplementary Document	Uploaded 2020-02-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226561	Follow-up Survey for 15 months	Other-survey	Removed
226560	Follow-up Survey for 9 months	Other-survey	Modified
223271	Youth Focus Group	Other-Protocol	Removed
223270	Program Fidelity Checklist	Other-checklist	Removed
223269	Program Attendance Data Collection Protocol	Other-attendance	Removed
223268	Staff Survey	Other-survey	Removed
223267	Master Topic Guide for Staff Interviews	Other-survey	Removed
223265	Baseline Survey of impact study participants	Instruction	Removed

ICR Details

OMB Control No: 0990-0452	ICR Reference No: 201912-0990-001
Status: Active	Previous ICR Reference No: 201704-0990-005
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Federal Evaluation of Making Proud Choices! (MPC!)
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: 04/09/2020
	Date Received in OIRA: 03/09/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2023	36 Months From Approved	08/31/2020
Responses	200	0	3,086
Time Burden (Hours)	100	0	1,393
Cost Burden (Dollars)	0	0	0

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Abstract: The federal evaluation of Making Proud Choices! (MPC!) is being conducted in 39 schools nationwide. The data collected from the baseline and follow-up instruments will be used to describe the characteristics of the study sample of youth, being used in the models for estimating program impacts, and provide a detailed understanding of program implementation. The revision is requested to update the burden to reflect an additional cohort of youth (estimated total of 600 youth over 3 years or 200 youth annually) from the current sites, to expand the data collection period to allow for collection of the 9 month follow-up from the additional cohort, and to update the burden estimate to reflect that the second follow-up survey (15 months post-baseline) was dropped. No changes to the actual content of the 9 month follow-up survey tool have been proposed as part of this revision request.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act Section 301
  

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:
	84 FR 69755	12/19/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 10702	02/25/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Staff Survey
Program Fidelity Checklist
Youth Focus Group
Follow-up Survey for 15 months
Follow-up Survey for 9 months
Master Topic Guide for Staff Interviews
Program Attendance Data Collection Protocol
Baseline Survey of impact study participants

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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	200	3,086	0	-619	-2,267	0
Annual Time Burden (Hours)	100	1,393	0	-310	-983	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: OPA estimates 200 youth annually (up to 600 youth over 3 years) would receive the 9-month follow-up survey/questionnaire during the requested ICR revision/extension period, with a burden per survey of 30 minutes, and thus a total of 100 hours annual burden is anticipated to be associated with this ICR extension with change. The adjustments in burden reflect the miscellaneous actions. First, OPA (formerly OAH) already concluded the collection of 5 information collections under the current valid ICR and therefore does not request or require extension of the following 5 information collections: Baseline Survey of impact study participants, Master Topic Guide for Staff Interviews, Staff Survey, Program Attendance Data Collection Protocol, Program Fidelity Checklist, and the Youth Focus Group. Next, the 9-month post-test survey participant numbers were reduced to reflect a final single cohort. In addition, OPA did not fund collection of the 15-month follow-up survey/questionnaire, so the burden associated with this information collection is not included in the burden estimate for the extension with change.

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Annual Cost to Federal Government: $132,014

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: 03/09/2020

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