Justification for the Collection of Information for Local Evaluations as part of the Personal Responsibility Education Program (PREP): Promising Youth Programs (PYP)

Formative Data Collections for ACF Program Support

Instrument 1a Impact CONSORT Diagram Template

Justification for the Collection of Information for Local Evaluations as part of the Personal Responsibility Education Program (PREP): Promising Youth Programs (PYP)

OMB: 0970-0531

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CONSORT Diagram for Clusters and for Youth











































Shape1

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this collection is 0970-XXXX; this number is valid through XX/XX/XXXX.  Public reporting burden for this collection of information is estimated to average XX minutes, including the time for reviewing instructions, gathering and maintaining the data needed, and reviewing the collection of information. This collection of information is voluntary for individuals, but the information is required from Grantees.





CONSORT Diagram for Clusters (Consent After Assignment) (if applicable)

*Complete based on pooled sample to date. Also complete diagram for youth, using only retained clusters.

Shape2

Describe what makes a cluster eligible for the evaluation; the number of clusters screened and the screening criteria used; the number of clusters determined to be eligible; the counts and reasons for those screened out; and whether and how any clusters were prioritized for inclusion in the study sample.




Shape3

Key dates

This diagram reflects sample enrolled through (date): __________­­­­­­­

This diagram reflects survey data collected through (date): __________



Shape31 Shape10 Shape5 Shape30 Shape11 Shape4 Shape9 Shape26 Shape18 Shape12 Shape13 Shape28 Shape16 Shape24 Shape20 Shape8 Shape29 Shape15 Shape27 Shape17 Shape25 Shape19 Shape23 Shape21 Shape22 Shape14 Shape7 Shape6

Did not pass screening criteria (n = __)

Other (n = __)


Assigned to Comparison (n = __)

Assigned to Treatment (n = __)

Completed baseline data collection (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)

Completed baseline data collection (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)


Primary analysis sample (n = __)


List reason(s) for cluster(s) being excluded

  • ___ (n=__)

  • ___ (n=__)






Retained at immediate post (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)




Retained at first follow up (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)


Retained at second follow up (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)


Primary analysis sample (n = __)


List reason(s) for cluster(s) being excluded

  • ___ (n=__)

  • ___ (n=__)






Retained at second follow up (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)






Retained at first follow up (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)






Retained at immediate post (n = __)


List reason(s) for cluster(s) non-completes

  • ___ (n=__)

  • ___ (n=__)






Clusters Randomized (n = __)

Date(s) of Cluster Random Assignment ______

Shape32

Key dates

This diagram reflects sample enrolled through (date): __________­­­­­­­

This diagram reflects survey data collected through (date): __________

CONSORT Diagram for Youth (Consent After Assignment)

*Complete based on pooled sample to date.

Shape33

Describe what makes a youth eligible for the evaluation; the number of youth screened and determined to be eligible; the counts and reasons for those screened out; and the process for selecting the study participants among those eligible.







Shape34 Shape35 Shape36

Did not receive parental consent (n = __)

Did not pass screening criteria (n = __)

Other (n = __)




Shape56 Shape57 Shape69 Shape52 Shape53 Shape46 Shape44 Shape66 Shape68 Shape64 Shape63 Shape67 Shape43 Shape42 Shape45 Shape47 Shape51 Shape50 Shape54 Shape55 Shape58 Shape59 Shape61 Shape60 Shape48 Shape49 Shape65 Shape37 Shape38 Shape41 Shape62 Shape40 Shape39

Agreed to be in the study (n = __)

Agreed to be in the study (n = __)

Completed baseline (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)





Completed baseline (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)




Eligible for immediate post (n = __)

Completed immediate post (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)




Eligible for immediate post (n = __)

Completed immediate post (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)




Eligible for first follow-up (n = __)

Completed first follow up (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)




Eligible for first follow-up (n = __)

Completed first follow-up (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)





Eligible for second follow-up (n = __)

Completed second follow up (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)

Eligible for second follow-up (n = __)

Completed second follow-up (n = __)

Date(s) of data collection:


List reasons for non-completes

  • ___ (n=__)

  • ___ (n=__)





Primary analysis sample (n = __)


List reason(s) for exclusion

  • ___ (n=__)

  • ___ (n=__)






Primary analysis sample (n = __)


List reason(s) for exclusion

  • ___ (n=__)

  • ___ (n=__)






Assigned to Comparison (n = __)

Assigned to Treatment (n = __)

Move “agreed to be in study” to correct sequence given your processes.

Randomized (n = __)

Date(s) of Random Assignment ______

Program start date(s):



Program end date(s):



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