Research Determination

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Form Version Date Nov. 2016

NCIPC Determination
General Information
Project Title

Collecting Violent Death Data Using the National Violent Death Reporting System (NVDRS)

Science Officer(s)Janet Blair
E-mail [email protected]

Ethics verification number:

Project Officer(s) Jamar Barnes

Division: DVP

Ex: MM/DD/YYYY

Telephone:

(770) 488-4416

Ethics verification number:

E-mail [email protected]

Proposed Project Dates:
9/1/2018
Ending:
Start:

Telephone: (770) 488-0049

Division: DVP

8/31/2022
Ex: MM/DD/YYYY

Funding Mechanism
• Cooperative Agreement #: CE10 1804
• Grant #:
• Contract#:
• No funding (Specify):

Funding FOA#:
Funding FOA#:

Describe the purpose, methods, and outcomes of the project (Use space provided - Abstract of purpose, methods and outcomes)

NVDRS is a surveillance system that utilizes state partners to create and implement a plan to collect
and disseminate accurate, timely, and comprehensive surveillance data on all violent deaths in a target
area using CDC guidelines and the CDC web-based data entry system. NVDRS is the first system to: 1)
provide detailed information on circumstances precipitating all types of violent deaths including brief
narratives that summarize what happened in the violent death incident, 2) combine information across
multiple data sources, and 3) link multiple deaths that are related to one another (e.g., multiple victim
homicides, suicide pacts, and cases of homicide followed by the suicide of the suspect). Data elements
are be collected from three sources: death certificates, coroner/medical examiner reports (including
toxicology reports), and law enforcement reports. These data are subsequently disseminated to key
stakeholders including, but not limited to, state/local/federal partners, government officials,
organizations working to prevent violence, and the public through a variety of strategies including, but
not limited to, reports, presentations, or fact sheets.

Describe the roles and responsibilities of CDC and any partner organizations (e.g., grantee, contractor).

Participating VDRS states collect information on who dies violently, where victims are killed, when they
are killed, and what factors were perceived to contribute to the death or were precipitating factors.

CDC 0.1485 (E), January 2017, CDC Adobe Acrobat DC, S508 Electronic Version, January 2017

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Form Version Date Nov. 2016

NCIPC Determination
Project Title:
Collecting Violent Death Data U

Proposed Project Dates:
91/2018
Start:

Ending:

8/31/2022

Applicability of Human Subjects Regulations
Please check appropriate category:
✔

I. Activity is not research. Primary intent is public health practice: disease/injury control, surveillance,
improvement of programs or services. Objectives focused on a specific population.
___ A. Epidemic/endemic disease/injury control activity; collected data directly relate to immediate disease
control needs (e.g., epi-aid).
✔ B. Routine disease/injury surveillance activity; data used for disease control program or policy purposes
___
for a specific health condition/disease in a specific population and setting. (Includes disease reporting)
___ C. Program evaluation/monitoring activity; data are used primarily for assessing, monitoring or
improving a program, policy, or a communications activity (e.g., message testing) in a specific
population/setting.
___ D. Purchase orders or contracts for services or equipment.
-ORII. Activity is research but does NOT involve human subjects. Primary intent is to develop or contribute to
generalizable knowledge, but data is obtained solely from non-human sources or not living individuals, or anonymous
existing data collected for another purpose are being analyzed:
___ A. Activity is research involving collection/analysis of data about health facilities or other
organizations or units, which are not individual persons
___ B. Activity is research using existing unlinked or anonymous data previously collected for another purpose.
___C. Activity is research involving data and/or specimens from deceased persons.

-ORIII. Activity is research involving human subjects but CDC is not engaged. CDC employees including visiting
scientists, fellows, and on-site contractors (but not off-site contractors or other collaborators
*Will NOT obtain consent or data by intervening or interacting with participants
*Will NOT have access to identifiable (including coded) private data or biological specimens
NOTE: Once local IRB approval has been obtained please forward a copy (electronic preferred) to the NCIPC Human
Subjects Coordinator for records keeping purposes.
-ORIV. Activity is research involving human subjects but exempt according to the categories specified in the
regulations 45 CFR 46.101(b). Educational practices, Educational tests, surveys, interviews, or observation of
public behavior. Existing data, documents, records (e.g., not identifiable, publicly available). Demonstration
projects.
-ORV. Activity is research involving human subjects, CDC is engaged, and CDC IRB approval will be sought.

CDC 0.1485 (E), January 2017, CDC Adobe Acrobat DC, S508 Electronic Version, January 2017

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Form Version Date Nov. 2016

Required Signatures

Digitally signed by
Jamar D. Barnes -S6
Date: 2018.08.08
17:04:27 -04'00'
Branch/Team Official (e.g., Branch chief or Team Lead)

Jamar D.
Barnes -S6

signed by
Kathleen C. Digitally
Kathleen C. Basile -S
Date: 2018.08.09
Basile -S
14:55:13 -04'00'
Division Official (e.g., ADS, Director)

Karen C.
Angel -S

Digitally signed by
Karen C. Angel -S
Date: 2018.08.09
11:47:25 -04'00'

Human Subjects Coordinator

08/08/2018
Date

08/09/2018
Date

08/09/2018
Date

Office Use Only

CDC 0.1485 (E), January 2017, CDC Adobe Acrobat DC, S508 Electronic Version, January 2017

Next Page

Previous Page

Form Version Date Nov. 2016

NCIPC Determination

Project Title:

Collecting Violent Death Data U

Proposed Project Dates:
Start:
91/2018

Ending:

8/31/2022

Applicability of OMB-PRA Regulations
Please check appropriate category:
I. Does the activity involve collecting identical information from 10 or more respondents within a one year period
Including evaluation/monitoring (Examples of collections: Surveys & Interviews (Phone & On-line) - Focus groups –
Surveillance – Program evaluation- Program monitoring).
No
✔

Yes - Type of collection:
Mail-back questionnaire
Testing/assessment form
Evaluation
Comment card
Other (Explain)

On-site questionnaire
Web-based survey
Observation

Personal interview
Focus groups
Workshop

✔

Telephone survey
Record abstractions
Discussion group

II. Is NCIPC Sponsoring the data collection? Check all that apply.
✔
✔

✔

✔

A. NCIPC will initiate or request a data collection.
B. NCIPC will develop or design the data collection.
C. NCIPC will manage or own the data collection.
D. NCIPC will be directing the data collection.
E. NCIPC staff will interact/intervene participants.
F. NCIPC is requesting specific data reports.
G. NCIPC will disseminate the data as an official report or study.
H. NCIPC is not conducting any of the above activities and therefore is not sponsoring the data
collection.

CDC 0.1485 (E), January 2017, CDC Adobe Acrobat DC, S508 Electronic Version, January 2017

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