Evaluation of Pregnancy Prevention Program Replications for High Risk and Hard to Reach Youth

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 6 focus group participation/protocol	Form and Instruction	New	Available
Form 7 Focus Group assent	Form and Instruction	New	Available
Form 5 3 month follow-up youth survey	Form and Instruction	New	Available
Form 4 youth follow-up survey	Form and Instruction	New	Available
Form 2 Youth Assent Form for Youth Survey	Form and Instruction	New	Available
Form 3 Youth baseline survey	Form	New	Available
Form 1 Parental consent for youth participation in study	Form and Instruction	New	Available
Appendix L_Follow-up Survey Export from Qualtrics.docx	Supplementary Document	Uploaded 2020-04-16	Available
Appendix K_Baseline Survey Export from Qualtrics.docx	Supplementary Document	Uploaded 2020-04-16	Available
Appendix H_IRB Approval_A080-M20-076.docx	Supplementary Document	Uploaded 2020-04-16	Available
Appendix G_ Certificate of Confidentiality_CC-OD-20-38.pdf	Supplementary Document	Uploaded 2020-04-16	Available
OASH Task 3_OMB PRA_SSA_4.9.2020.docx	Supporting Statement A	Uploaded 2020-04-16	Available
Published 60-day 0990-Evaluation of PP Program Replication_ high risk.pdf	Supplementary Document	Uploaded 2020-01-09	Available
OASH Task 3_OMB PRA_SSB.docx	Supporting Statement B	Uploaded 2020-01-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239304	Focus group participation/protocol	Form and Instruction	New	focus group participation/protocol
239211	Focus Group Assent Form	Form and Instruction	New	Focus Group assent
239210	3 month follow-up survey	Form and Instruction	New	3 month follow-up youth survey
239209	Follow-up Survey	Form and Instruction	New	youth follow-up survey
239207	Youth Baseline Form and Assent	Form and Instruction	New	Youth Assent Form for Youth Survey
239207	Youth Baseline Form and Assent	Form	New	Youth baseline survey
239206	Parental Consent Form	Form and Instruction	New	Parental consent for youth participation in study

ICR Details

OMB Control No: 0990-0472	ICR Reference No: 202001-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Evaluation of Pregnancy Prevention Program Replications for High Risk and Hard to Reach Youth
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: 04/17/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/04/2020
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
Responses	11,610	0	0
Time Burden (Hours)	4,859	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 specific to Pregnancy Prevention Programs for Adolescents: A Replication Study. The request is for 24 months. OASH is proposing to conduct an independent evaluation examining whether programs that have been proven effective through rigorous evaluation can be replicated with similarly successful and consistent results among hard-to-reach, high-risk, vulnerable, or understudied youth. The independent evaluator, MITRE, will use a quasi-experimental design to measure program effects on youth knowledge, attitudes, beliefs, intentions, and behaviors related to sexual health. The evaluation will also examine youth perspectives regarding participation in adolescent pregnancy prevention programs. Up to eight implementing organizations—organizations focused on health, education, and social services that have experience working with community-based organizations to implement pregnancy prevention programs for adolescents—will implement previously proven-effective adolescent pregnancy prevention programs for up to 1,900 youth. Baseline data will be collected from a matched comparison group with a subset of these participating program youth. Findings will inform OASH’s programmatic efforts to improve sexual health knowledge, attitudes, beliefs, intentions, and behaviors among hard-to-reach, vulnerable, or understudied youth.

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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:
	84 FR 216	11/07/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 5217	01/29/2020
Did the Agency receive public comments on this ICR? No

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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
3 month follow-up survey	5	3 month follow-up youth survey
Focus Group Assent Form	7	Focus Group assent
Focus group participation/protocol	6	focus group participation/protocol
Follow-up Survey	4	youth follow-up survey
Parental Consent Form	1	Parental consent for youth participation in study
Youth Baseline Form and Assent	2, 3	Youth Assent Form for Youth Survey ,   Youth baseline 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	11,610	0	0	11,610	0	0
Annual Time Burden (Hours)	4,859	0	0	4,859	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: $5,330,000

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 03/04/2020

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