Formative Research and Tool Development

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
School Staff Survey – Pre & Post Toolkit (Word)	Form and Instruction	New	Repair queued
Post-Pilot Feedback Interview Guide	Form and Instruction	New	Repair queued
Monthly Report Form	Form and Instruction	New	Repair queued
School Staff Survey – Pre & Post Toolkit	Form and Instruction	New	Repair queued
Climate Interview Consent and Guide	Form and Instruction	New	Repair queued
Form 0920-0840 School MTSS Team Members - MTSS School Level Focus Group	Form and Instruction	New	Repair queued
Form 0920-0840 District MTSS Team Members - District Implementation Checklist	Form and Instruction	New	Repair queued
Form 0920-0840 School MTS Team Members - School Implementation Checklist	Form and Instruction	New	Repair queued
Form 0920-0840 Middle/High School Students - Student Focus Groups	Form and Instruction	New	Repair queued
Form 0920-0840 District MTSS Team Members - Key Informant Interview	Form and Instruction	New	Repair queued
Form 0920-0840 School Administrators - Key Informant Interview	Form and Instruction	New	Repair queued
Form 0920-22IF Att5 SC Demo_Student Focus Group Guide	Form and Instruction	New	Repair queued
Form 0920-22IF Att4 SC Demo_Teacher Focus Group Guide	Form and Instruction	New	Repair queued
Form 0920-22IF Att3 SC Demo_Champion Focus Group Guide	Form and Instruction	New	Repair queued
Form 0920-22IF Att2 SC Demo_KII Interview Guide	Form and Instruction	New	Repair queued
Form 0920-0840 Pre=Post School Staff Survey	Form and Instruction	New	Available
Form 0920-0840 LGBTQ Inclusivity Toolkit Demonstration Project Post-Pilot Feedback Interview Guide	Form and Instruction	New	Available
Form 0920-0840 LGBTQ Inclusivity Toolkit Demonstration Project Monthly Report Form	Form and Instruction	New	Available
Form 0920-0840 Pre-Post School Staff Survey Monkey	Form and Instruction	New	Available
Form 0920-0840 Student Survey	Form and Instruction	New	Repair queued
Form 0920-0840 Teacher Survey	Form and Instruction	New	Repair queued
Form 0920-0840 #1 E-learning module survey- Trauma informed approach	Form	New	Repair queued
Form 0920-0840 Micro Session Survey	Form	New	Repair queued
Form 0920-0840 In-person training evaluation	Form	New	Repair queued
Form 0920-0840 #2 E-learning module survey- Culturally Responsive Health Education Classroom	Form	New	Repair queued
Form 0920-0840 #3 E-learning module survey- Basic Principles of Teaching Health Education	Form	New	Repair queued
Form 0920-0840 #2 Webinar- Assess and Adjust:	Form	New	Repair queued
Form 0920-0840 #1 Webinar- Adolescent Growth and Development	Form	New	Repair queued
Att 10 List of Approved ICRs.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
Att 9 Example Consent Form.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
Att 8 DHAP ConfidAssurance.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
Att 7 Example Group Interview Guide.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
Att 6 Sample Screening Tool 8-2.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
Att 5 Example Survey.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
Att 4 Example Individual Interview Guide.docx	Supplementary Document	Uploaded 2021-05-17	Repair queued
Att 3 Example Questions 8-2.docx	Supplementary Document	Uploaded 2021-05-14	Repair queued
Published 60dy210840.pdf	Supplementary Document	Uploaded 2021-05-14	Repair queued
Att 1 AuthLegislation.docx	Supplementary Document	Uploaded 2021-05-18	Repair queued
SSB.docx	Supporting Statement B	Uploaded 2021-05-14	Repair queued
SSA.docx	Supporting Statement A	Uploaded 2021-05-18	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260956	[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	Form and Instruction	New	School Staff Survey – Pre & Post Toolkit (Word)
260956	[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	Form and Instruction	New	Post-Pilot Feedback Interview Guide
260956	[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	Form and Instruction	New	Monthly Report Form
260956	[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	Form and Instruction	New	School Staff Survey – Pre & Post Toolkit
260956	[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	Form and Instruction	New	Climate Interview Consent and Guide
260956	[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	Instruction	New
255648	DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	Form and Instruction	New	School MTSS Team Members - MTSS School Level Focus Group
255648	DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	Form and Instruction	New	District MTSS Team Members - District Implementation Checklist
255648	DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	Form and Instruction	New	School MTS Team Members - School Implementation Checklist
255648	DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	Form and Instruction	New	Middle/High School Students - Student Focus Groups
255648	DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	Form and Instruction	New	District MTSS Team Members - Key Informant Interview
255648	DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	Form and Instruction	New	School Administrators - Key Informant Interview
255303	DASH COVID-19 School Connectedness Formative Evaluation - Pilot Study	Form and Instruction	New	Att5 SC Demo_Student Focus Group Guide
255303	DASH COVID-19 School Connectedness Formative Evaluation - Pilot Study	Form and Instruction	New	Att4 SC Demo_Teacher Focus Group Guide
255303	DASH COVID-19 School Connectedness Formative Evaluation - Pilot Study	Form and Instruction	New	Att3 SC Demo_Champion Focus Group Guide
255303	DASH COVID-19 School Connectedness Formative Evaluation - Pilot Study	Form and Instruction	New	Att2 SC Demo_KII Interview Guide
254269	DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation	Form and Instruction	New	Pre=Post School Staff Survey
254269	DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation	Form and Instruction	New	LGBTQ Inclusivity Toolkit Demonstration Project Post-Pilot Feedback Interview Guide
254269	DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation	Form and Instruction	New	LGBTQ Inclusivity Toolkit Demonstration Project Monthly Report Form
254269	DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation	Form and Instruction	New	Pre-Post School Staff Survey Monkey
254269	DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation	Instruction	New
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form and Instruction	New	Student Survey
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form and Instruction	New	Teacher Survey
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	#1 E-learning module survey- Trauma informed approach
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	Micro Session Survey
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	In-person training evaluation
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	#2 E-learning module survey- Culturally Responsive Health Education Classroom
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	#3 E-learning module survey- Basic Principles of Teaching Health Education
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	#2 Webinar- Assess and Adjust:
253397	DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	Form	New	#1 Webinar- Adolescent Growth and Development

ICR Details

OMB Control No: 0920-0840	ICR Reference No: 202103-0920-001
Status: Historical Active	Previous ICR Reference No: 201808-0920-023
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0840
Title: Formative Research and Tool Development
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/13/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/08/2021
Terms of Clearance: Previous terms continue: OMB approves this umbrella generic, and has informed CDC that each individual study should be submitted into ROCIS an a genIC that includes the actual study instruments and a memo describing the specific study goal, the study design, any incentives to be used, and the sampling and analysis plans.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2024	36 Months From Approved	10/31/2021
Responses	121,800	0	121,800
Time Burden (Hours)	46,516	0	46,516
Cost Burden (Dollars)	2,348,936	0	2,348,936

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Abstract: The CDC NCHHSTP has greatly benefitted from this Formative Research and Tools Development Generic Information Collection, OMB #0920-0840. Since receiving the 2018 OMB approval, 7 generic information collection requests (ICRs) have been approved under the Formative Research and Tool Development Generic Clearance (Attachment 10). With this information collection, CDC has conducted formative research to inform the development of and refinement of our HIV prevention messages, collect information on student and teacher perspectives on sexual health and issues related to sexual health and men who have sex with men (MSM). For example, CDC has been able to developed and tested materials to examine jail and prison policies to reduce STD rates. Under this mechanism, CDC has developed a mobile message intervention for MSM with the purpose of using formative research to develop and assess HIV prevention messages tailored for men who have sex with men (MSM) in the United States, including informational and motivational messages about recent advances in biomedical HIV prevention.. This Generic gives CDC the opportunity to obtain qualitative feedback that we need to be able to develop and adapt our campaigns, which are vital to the CDC/NCHHSTP mission in a timely manner.

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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:
	86 FR 9346	02/12/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 26515	05/14/2021
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
DASH COVID-19 Demonstration: Mental Health Formative Evaluation and Pilot Study	0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840	School Administrators - Key Informant Interview ,   District MTSS Team Members - Key Informant Interview ,   Middle/High School Students - Student Focus Groups ,   School MTS Team Members - School Implementation Checklist ,   District MTSS Team Members - District Implementation Checklist ,   School MTSS Team Members - MTSS School Level Focus Group
DASH COVID-19 School Connectedness Formative Evaluation - Pilot Study	0920-22IF, 0920-22IF, 0920-22IF, 0920-22IF	Att2 SC Demo_KII Interview Guide ,   Att3 SC Demo_Champion Focus Group Guide ,   Att4 SC Demo_Teacher Focus Group Guide ,   Att5 SC Demo_Student Focus Group Guide
DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study	0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840, 0920-0840	#1 Webinar- Adolescent Growth and Development ,   #2 Webinar- Assess and Adjust: ,   #3 E-learning module survey- Basic Principles of Teaching Health Education ,   #2 E-learning module survey- Culturally Responsive Health Education Classroom ,   In-person training evaluation ,   Micro Session Survey ,   #1 E-learning module survey- Trauma informed approach ,   Teacher Survey ,   Student Survey
DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation	0920-0840, 0920-0840, 0920-0840, 0920-0840	Pre-Post School Staff Survey Monkey ,   LGBTQ Inclusivity Toolkit Demonstration Project Monthly Report Form ,   LGBTQ Inclusivity Toolkit Demonstration Project Post-Pilot Feedback Interview Guide ,   Pre=Post School Staff Survey
[NCHHSTP] DASH DEMO: LGBTQ Inclusivity Toolkit Evaluation 2022-2024	n/a, n/a, n/a, n/a, n/a	Climate Interview Consent and Guide ,   School Staff Survey – Pre & Post Toolkit ,   Monthly Report Form ,   Post-Pilot Feedback Interview Guide ,   School Staff Survey – Pre & Post Toolkit (Word)

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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	121,800	121,800	0	0	0	0
Annual Time Burden (Hours)	46,516	46,516	0	0	0	0
Annual Cost Burden (Dollars)	2,348,936	2,348,936	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $574,500

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 06/08/2021

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