Components Study of REAL Essentials

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment C1_Study Parental Consent_CLEAN.docx	Supplementary Document	Uploaded 2022-01-07	Repair queued
0990-0480_Justification Non Sub Change Memo_010522_CLEAN.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2022-01-13	Repair queued
Real Essentials study 30D comment response.docx	Supplementary Document	Uploaded 2021-10-14	Repair queued
2021-18886 real essentials components.pdf	Supplementary Document	Uploaded 2021-09-01	Repair queued
Attachment G_60 day FRN.pdf	Supplementary Document	Uploaded 2021-07-21	Repair queued
Attachment F_Persons Consulted.docx	Supplementary Document	Uploaded 2021-07-21	Repair queued
Attachment E_Youth Focus Group Assent_CLEAN.docx	Supplementary Document	Uploaded 2022-01-07	Missing upstream
Attachment D_Youth Survey Assent.docx	Supplementary Document	Uploaded 2021-07-21	Repair queued
Attachment C2_Study Parental Consent_youth engagement_CLEAN.docx	Supplementary Document	Uploaded 2022-01-07	Repair queued
Attachment B_Youth Outcome Survey Item Source List.docx	Supplementary Document	Uploaded 2021-07-21	Repair queued
Attachment A Section 301 Public Health Service Act.docx	Supplementary Document	Uploaded 2021-07-21	Repair queued
SSB - Components Study final.docx	Supporting Statement B	Uploaded 2021-10-14	Repair queued
SSA - Components Study final.docx	Supporting Statement A	Uploaded 2021-10-14	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
248671	Youth Outcome Survey	Other-survey and instruction	Modified
248669	Youth focus group topic guide	Other-discussion topic guide	Unchanged
248667	Youth Engagement Exit Ticket	Other-exit ticket survey and instruction	Unchanged
248508	Program Facilitators- Fidelity log	Other-instruction and log	Unchanged
248502	Program Facilitators- interview topic guide	Instruction	Unchanged
248501	District/School/CBO leadership- interview topic guide	Other-interview topic guide	Unchanged

ICR Details

OMB Control No: 0990-0480	ICR Reference No: 202201-0990-002
Status: Received in OIRA	Previous ICR Reference No: 202107-0990-002
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Components Study of REAL Essentials
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/13/2022

table that charts list comparision

	Requested	Previously Approved
Expiration Date	10/31/2024	10/31/2024
Responses	8,367	8,367
Time Burden (Hours)	1,488	1,488
Cost Burden (Dollars)	0	0

---

Abstract: The Office of Population Affairs (OPA), U.S. Department of Health and Human Services (HHS) is requesting 3 years of approval by OMB on a new collection. The Components Study of REAL Essentials Curriculum will identify the components that matter the most for promoting positive health behaviors and outcomes among adolescents. The study will examine program components (for example, content and dosage), implementation components (for example, attendance and engagement), and contextual components (for example, participant characteristics) to determine which components influence participant outcomes the most. In addition, the study will measure youth engagement in programming from various perspectives and examine the role of engagement as a mediating factor to achieving youth outcomes. Sites participating in the study will use the REAL Essentials Advance (REA) relationship curriculum, a popular program among federal pregnancy prevention grantees. The study will enroll schools from spring to fall 2022 (and possibly spring 2023, if necessary). The study will collect youth surveys at baseline, at program exit, and 6 months following the completion of the program. The study will also collect extensive implementation data, which includes youth engagement exit ticket surveys after REA sessions, focus groups with youth, program facilitator logs, and attendance records. Study staff will also interview facilitators and site leadership.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Section 301 of the Public Health Service Act (42 U.S.C.241)
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 18544	04/09/2021
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 49037	09/01/2021
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
District/School/CBO leadership- interview topic guide
Program Facilitators- Fidelity log
Program Facilitators- interview topic guide
Youth Engagement Exit Ticket
Youth Outcome Survey
Youth focus group topic guide

---

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	8,367	8,367	0	0	0	0
Annual Time Burden (Hours)	1,488	1,488	0	0	0	0
Annual Cost Burden (Dollars)	0	0	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:

---

Annual Cost to Federal Government: $416,908

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.     Yes

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: 01/13/2022

---