Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Youth Respondent Questionnaire	Form and Instruction	New	Repair queued
Youth Respondent Consent/Assent	Form and Instruction	New	Repair queued
Head of Household Questionnaire	Form and Instruction	New	Repair queued
Head of Household Consent	Form and Instruction	New	Repair queued
Screener Questionnaire	Form and Instruction	New	Repair queued
Invitation Letter	Form	New	Repair queued
Cognitive Interview Protocol	Form and Instruction	New	Repair queued
Cognitive interviewing consent/assent	Form and Instruction	New	Repair queued
Informed parental consent	Form and Instruction	New	Repair queued
Cognitive interview screening	Form and Instruction	New	Repair queued
Cognitive interview response to flyer/ telephone inquiry	Form and Instruction	New	Repair queued
Cognitive interview screening	Form and Instruction	New	Repair queued
Cognitive interview response to flyer/ telephone inquiry	Form and Instruction	New	Repair queued
Youth participant questionnaire	Form	New	Repair queued
Youth participant consent	Form and Instruction	New	Repair queued
Head of household questionnaire	Form	New	Available
Head of household Consent	Form and Instruction	New	Repair queued
Screener	Form and Instruction	New	Repair queued
Invitation to participate	Form and Instruction	New	Repair queued
AttachmentG_IRB Approval.pdf	Supplementary Document	Uploaded 2020-12-15	Repair queued
AttachmentC_Privacy Impact Assessment (PIA).pdf	Supplementary Document	Uploaded 2020-12-15	Repair queued
AttachmentB_ 60 Dy FRN VACS.pdf	Supplementary Document	Uploaded 2020-12-15	Repair queued
AttachmentA_ Authorizing Legislation.docx	Supplementary Document	Uploaded 2020-12-15	Repair queued
SSB__VACS_12.14.2020.docx	Supporting Statement B	Uploaded 2020-12-15	Repair queued
SSA _ VACS_12.14.2020.docx	Supporting Statement A	Uploaded 2020-12-15	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
250663	Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire	Form and Instruction	New	Youth Respondent Questionnaire
250654	Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Consent/Assent	Form and Instruction	New	Youth Respondent Consent/Assent
250653	Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Household Questionnaire	Form and Instruction	New	Head of Household Questionnaire
250651	Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Houehold Consent	Form and Instruction	New	Head of Household Consent
250648	Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire	Form and Instruction	New	Screener Questionnaire
250647	Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter	Form	New	Invitation Letter
250646	Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol	Form and Instruction	New	Cognitive Interview Protocol
250644	Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent	Form and Instruction	New	Cognitive interviewing consent/assent
250643	Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent	Form and Instruction	New	Informed parental consent
250641	Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening	Form and Instruction	New	Cognitive interview screening
250640	Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry	Form and Instruction	New	Cognitive interview response to flyer/ telephone inquiry
250639	Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening	Form and Instruction	New	Cognitive interview screening
250638	Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry	Form and Instruction	New	Cognitive interview response to flyer/ telephone inquiry
244953	Youth participant questionnaire	Form	New
244952	Youth participant consent	Form and Instruction	New
244951	Head of household questionnaire	Form	New
244949	Head of household Consent	Form and Instruction	New
244941	Screener	Form and Instruction	New
244940	Invitation to participate	Form and Instruction	New

ICR Details

OMB Control No: 0920-1356	ICR Reference No: 202012-0920-010
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20QO
Title: Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US
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 with change	Conclusion Date: 12/03/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 01/11/2021
Terms of Clearance: Approved consistent with the understanding that CDC will submit any changes made based upon cognitive testing in advance of proceeding to piloting.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2024	36 Months From Approved
Responses	8,449	0	0
Time Burden (Hours)	872	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This request is to conduct the Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the United States, which CDC has conducted in 24 countries globally and has adapted for a domestic context. More specifically, this request details the adaptations to the survey and methods for piloting the survey in one urban and one rural area of the United States.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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 45432	07/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 1111	01/07/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Household Questionnaire	NA	Head of Household Questionnaire
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter	NA	Invitation Letter
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Houehold Consent	NA	Head of Household Consent
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire	NA	Screener Questionnaire
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening	NA	Cognitive interview screening
Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry	NA	Cognitive interview response to flyer/ telephone inquiry
Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent	NA	Informed parental consent
Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol	NA	Cognitive Interview Protocol
Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent	NA	Cognitive interviewing consent/assent
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry	NA	Cognitive interview response to flyer/ telephone inquiry
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening	NA	Cognitive interview screening
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Consent/Assent	NA	Youth Respondent Consent/Assent
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire	NA	Youth Respondent Questionnaire

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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	8,449	0	0	8,449	0	0
Annual Time Burden (Hours)	872	0	0	872	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: This is a new ICR.

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Annual Cost to Federal Government: $1,960,867

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: 01/11/2021

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