National Youth Risk Behavior Survey Test-Retest Reliability Study

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920- Permission Form Checklist	Form	New	Repair queued
Form 0920- School Recruitment Script	Form and Instruction	New	Repair queued
Form 0920- District Recruitment Script	Form and Instruction	New	Repair queued
Form 0920- YRBS Questionnaire	Form and Instruction	New	Available
Att O PIA_YRBS Test_Retest.pdf	Supplementary Document	Uploaded 2020-12-11	Repair queued
Att L-Fact Sheet.docx	Supplementary Document	Uploaded 2020-12-11	Missing upstream
Att K-Passive Parent Consent Form.docx	Supplementary Document	Uploaded 2020-12-11	Repair queued
Att J-Active Parent Consent Form.docx	Supplementary Document	Uploaded 2020-12-11	Repair queued
Att I-IRB Approval Letter.pdf	Supplementary Document	Uploaded 2020-12-11	Repair queued
Att F-Adv. Principal Letter.docx	Supplementary Document	Uploaded 2020-12-11	Missing upstream
Att D-Adv. Superintendent Letter.docx	Supplementary Document	Uploaded 2020-12-11	Repair queued
SSB.docx	Supporting Statement B	Uploaded 2020-12-11	Repair queued
SSA.docx	Supporting Statement A	Uploaded 2020-12-11	Repair queued
Att A-Authorizing Legislation.docx	Supplementary Document	Uploaded 2020-12-11	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
244895	Permission Form Checklist	Form	New
244894	School Recruitment Script	Form and Instruction	New
244893	District Recruitment Script	Form and Instruction	New
244892	YRBS Questionnaire	Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202012-0920-007
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20OJ
Title: National Youth Risk Behavior Survey 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	Date Submitted to OIRA: 12/23/2020

table that charts list comparision

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	2,120	0
Time Burden (Hours)	1,540	0
Cost Burden (Dollars)	0	0

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Abstract: The goal of the National Youth Risk Behavior Survey Test-Retest Reliability Study is to test the reliability of the data collected through the national Youth Risk Behavior Survey questionnaire.

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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:
	85 FR 33673	06/02/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 83090	12/21/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
YRBS Questionnaire	0920-	2021 National Youth Risk Behavior Survey
District Recruitment Script	0920-	District Recruitment Script
School Recruitment Script	0920-	School Recruitment Script
Permission Form Checklist	0920-	Permission Form Checklist

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ICR Summary of Burden

table that charts list of burden

	Total Request	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	2,120	0	0	2,120	0	0
Annual Time Burden (Hours)	1,540	0	0	1,540	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 (Request for a new OMB Control Number)

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Annual Cost to Federal Government: $79,296

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.     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? 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: 12/23/2020

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