Personalized Web-based Sexual Assault Prevention for Service Members

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0703-PWSP_SSA_1.26.2022.docx	Supporting Statement A	Uploaded 2022-01-26	Missing upstream
0703-PWSP_SSB_1.18.2022.docx	Supporting Statement B	Uploaded 2022-01-18	Missing upstream
TAB A Emergency Justification Letter_Signed.pdf	Supplementary Document	Uploaded 2022-01-05	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
251184	Pre and Post Interview/Focus Group Surveys	Other-Survey	New
251031	Sexual Assault Prevention in Service Members Normative Survey	Other-Survey	New

ICR Details

OMB Control No:	ICR Reference No: 202201-0703-001
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: DOD/NAVY	Agency Tracking No: 0703-PWSP
Title: Personalized Web-based Sexual Assault Prevention for Service Members
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Emergency	Approval Requested By: 02/04/2022
Date Submitted to OIRA: 01/26/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	6 Months From Approved
Responses	674	0
Time Burden (Hours)	230	0
Cost Burden (Dollars)	3,318	0

---

Abstract: The aim of this survey is to assist in the adaptation of an existing web-based sexual assault prevention program for college men and women, for use among the Navy population. Responses to the survey will provide information about the behavior and attitudes of Sailors regarding alcohol use and sexual assault. The results of the survey will impact the Department of the Navy by documenting the feasibility, acceptability, satisfaction, and utility of a multi-pronged, individually tailored, and easily distributed prevention program that addresses the large problem of sexual assault, and the associated effects of alcohol for Sailors. In the long-term, this research benefits the readiness of the force by producing an easily disseminated high-quality sexual assault prevention program that can be implemented in multiple military settings and sustain evaluation in a larger clinical trial. This research can also have a secondary impact on reducing hazardous alcohol use among service members and can prevent the occurrence of alcohol use problems and associated negative health sequelae in service members.

Emergency Justfication: This information must be collected prior to the time periods established under 5 CFR Part 1320 of the regulations and this information collection is essential to ensure that this CDMRP-funded project is not delayed any further. This NHRC IRB-approved project was meeting scheduled milestones; however, is now behind schedule due to delays in receiving a determination from the Navy Survey Approval Office. Considering that the funding agency requires that specific project milestones are achieved by set dates, we are requesting an expedited approval of the survey to ensure that this project is not delayed further. If OMB emergency clearance is not granted, data necessary for the sexual assault prevention intervention development and adaption will not be available and will significantly affect study execution.

---

Authorizing Statute(s): None

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Pre and Post Interview/Focus Group Surveys
Sexual Assault Prevention in Service Members Normative Survey

---

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	674	0	0	674	0	0
Annual Time Burden (Hours)	230	0	0	230	0	0
Annual Cost Burden (Dollars)	3,318	0	0	3,318	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 a new information collection with a new associated burden.

---

Annual Cost to Federal Government: $0

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

---

Common Form ICR:  No

---

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: 01/26/2022

---