School Health Profiles Test-Retest Reliability Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Time 2 Supplemental Questions	Form and Instruction	New	Available
Teacher Supplemental Questions (Time 2)	Form and Instruction	New	Repair queued
Lead Health Education Teacher Questionnaire	Form and Instruction	New	Available
Teacher Questionnaire (Time 2)	Form and Instruction	New	Repair queued
Lead Health Education Teacher Questionnaire	Form and Instruction	New	Available
Teacher Questionnaire (Time 1)	Form and Instruction	New	Repair queued
Time 2 Supplemental Questions	Form and Instruction	New	Available
School Principal Supplemental Questions (Time 2)	Form and Instruction	New	Repair queued
School Principal Questionnaire	Form and Instruction	New	Available
School Principal Questionnaire (Time 2)	Form and Instruction	New	Repair queued
School Principal Questionnaire	Form and Instruction	New	Available
School Principal Questionnaire (Time 1)	Form and Instruction	New	Repair queued
AttV-PIA_Profiles Test -Retest-20KW sej.pdf	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttU-Westat IRB Approval.pdf	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttT-T2 Follow-up Mailings-Web 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttS-T2 Follow-up Mailings-Paper 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttR-T2 Reminder Postcards-Web 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Available
AttQ-T2 Reminder Postcards-Paper 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttP-T2 Initial Mailing-Web 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttO-T2 Initial Mailing-Paper 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttM-T1 Follow-up Mailings-Web 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Available
AttL-T1 Follow-up Mailings-Paper 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttK-T1 Reminder Postcards-Web 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttJ-T1 Reminder Postcards-Paper 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttI-T1 Initial Mailing-Web 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttH-T1 Initial Mailing-Paper 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttG-Adv. Principal & Teacher Letters 8-11-20.docx	Supplementary Document	Uploaded 2020-08-14	Available
AttF-Adv. Superintendent Letter 8-11-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttB-1 60-day FRN Published 3-16-2020.pdf	Supplementary Document	Uploaded 2020-08-14	Repair queued
AttA-Authorizing Legislation 4-1-20.docx	Supplementary Document	Uploaded 2020-08-14	Repair queued
SSB 8-12-20.docx	Supporting Statement B	Uploaded 2020-08-14	Repair queued
SSA 8-12-20.docx	Supporting Statement A	Uploaded 2020-08-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
242972	Teacher Nonresponse Follow-up Call (Time 2)	Instruction	New
242971	Teacher Supplemental Questions (Time 2)	Form and Instruction	New	Time 2 Supplemental Questions
242971	Teacher Supplemental Questions (Time 2)	Form and Instruction	New
242969	Teacher Questionnaire (Time 2)	Form and Instruction	New	Lead Health Education Teacher Questionnaire
242969	Teacher Questionnaire (Time 2)	Form and Instruction	New
242968	Teacher Nonresponse Follow-up Call (Time 1)	Instruction	New
242966	Teacher Questionnaire (Time 1)	Form and Instruction	New	Lead Health Education Teacher Questionnaire
242966	Teacher Questionnaire (Time 1)	Form and Instruction	New
242964	School Principal Nonresponse Follow-up Call (Time 2)	Instruction	New
242962	School Principal Supplemental Questions (Time 2)	Form and Instruction	New	Time 2 Supplemental Questions
242962	School Principal Supplemental Questions (Time 2)	Form and Instruction	New
242961	School Principal Questionnaire (Time 2)	Form and Instruction	New	School Principal Questionnaire
242961	School Principal Questionnaire (Time 2)	Form and Instruction	New
242958	School Principal Nonresponse Follow-up Call (Time 1)	Instruction	New
242957	School Principal Questionnaire (Time 1)	Form and Instruction	New	School Principal Questionnaire
242957	School Principal Questionnaire (Time 1)	Form and Instruction	New

ICR Details

OMB Control No: 0920-1320	ICR Reference No: 202008-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20KW
Title: School Health Profiles Test-Retest Reliability Study
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 without change	Conclusion Date: 02/04/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/08/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2022	12 Months From Approved
Responses	1,800	0	0
Time Burden (Hours)	686	0	0
Cost Burden (Dollars)	26,540	0	0

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Abstract: The goal of the School Health Profiles Test-Retest Reliability Study is to assess the reliability of the data collected through the School Health Profiles School Principal and Lead Health Education Teacher questionnaires. Information will be collected at two time points, approximately two weeks apart, and compared. Additional information will be collected at the second time point to elucidate why responses stayed the same or changed. Findings will be used to improve the questionnaires.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service Act: Research and Investigations
  

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:
	85 FR 14942	03/16/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 55459	09/08/2020
Did the Agency receive public comments on this ICR? Yes

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

table that charts list of burden

IC Title	Form No.	Form Name
School Principal Nonresponse Follow-up Call (Time 1)
School Principal Nonresponse Follow-up Call (Time 2)
School Principal Questionnaire (Time 1)	n/a	School Principal Questionnaire
School Principal Questionnaire (Time 2)	n/a	School Principal Questionnaire
School Principal Supplemental Questions (Time 2)	n/a	Time 2 Supplemental Questions
Teacher Nonresponse Follow-up Call (Time 1)
Teacher Nonresponse Follow-up Call (Time 2)
Teacher Questionnaire (Time 1)	n/a	Lead Health Education Teacher Questionnaire
Teacher Questionnaire (Time 2)	n/a	Lead Health Education Teacher Questionnaire
Teacher Supplemental Questions (Time 2)	n/a	Time 2 Supplemental Questions

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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	1,800	0	0	1,800	0	0
Annual Time Burden (Hours)	686	0	0	686	0	0
Annual Cost Burden (Dollars)	26,540	0	0	26,540	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: This is a new information collection request.

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Annual Cost to Federal Government: $197,781

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.     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? No

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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: 09/08/2020

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