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

CONSORT Diagram for Clusters and for Youth

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.

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.

Key dates

This diagram reflects sample enrolled through (date): __________­­­­­­­

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

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 ______

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.

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.

Did not receive parental consent (n = __)

Did not pass screening criteria (n = __)

Other (n = __)

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):