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

Forms and Documents

Document Name	Status
Form 0920-22HW 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	Modified
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	Unchanged
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	Unchanged
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	Unchanged
Form 0920-22HW Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire Form and Instruction	Modified
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter Form	Unchanged
Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol Form and Instruction	Unchanged
Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent Form and Instruction	Unchanged
Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent Form and Instruction	Unchanged
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening Form and Instruction	Unchanged
Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry Form and Instruction	Unchanged
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening Form and Instruction	Unchanged
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry Form and Instruction	Unchanged
Attachment X_Cognitive Interview Report Final.docx Supplementary Document	2022-08-10
OMB_Change_Request_DVACS_Pilot_7 22 22.docx Justification for No Material/Nonsubstantive Change	2022-08-10
Attachment K_Screenshots.pdf Supplementary Document	2021-12-03
Attachment P_VACS Adaptation Expert Consultation Report_July 2017.pdf Supplementary Document	2021-12-03
Attachment O_Colombia 2017_VACS Cognitive Lab Report.pdf Supplementary Document	2021-12-03
Attachment N_Malawi 2013 NCHS_VACS Cognitive Lab Report.pdf Supplementary Document	2021-12-03
Attachment M_Philippines 2012 NCHS_VACS Cognitive Lab Report.pdf Supplementary Document	2021-12-03
Attachment L_Response Plan Distress Protocol_US VACS Adaptation.docx Supplementary Document	2021-12-03
AttachmentG_IRB Approval.pdf Supplementary Document	2020-12-15
AttachmentC_Privacy Impact Assessment (PIA).pdf Supplementary Document	2020-12-15
AttachmentB_ 60 Dy FRN VACS.pdf Supplementary Document	2020-12-15
AttachmentA_ Authorizing Legislation.docx Supplementary Document	2020-12-15
SSB__VACS_FINAL_v2.docx Supporting Statement B	2021-12-02
SSA__VACS_FINAL_v2.docx Supporting Statement A	2021-12-02

IC Document Collections

IC ID	Document Title	Status
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	Modified
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	Unchanged
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	Unchanged
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	Unchanged
250648	Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire Form and Instruction	Modified
250647	Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter Form	Unchanged
250646	Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol Form and Instruction	Unchanged
250644	Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent Form and Instruction	Unchanged
250643	Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent Form and Instruction	Unchanged
250641	Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening Form and Instruction	Unchanged
250640	Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry Form and Instruction	Unchanged
250639	Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening Form and Instruction	Unchanged
250638	Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry Form and Instruction	Unchanged

ICR Details

OMB Control No: 0920-1356	ICR Reference No: 202208-0920-008
Status: Received in OIRA	Previous ICR Reference No: 202012-0920-010
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-22HW
Title: Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US
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: 08/11/2022

	Requested	Previously Approved
Expiration Date	12/31/2024	12/31/2024
Responses	8,449	8,449
Time Burden (Hours)	872	872
Cost Burden (Dollars)	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

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	0920-22HW	Screening 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	0920-22HW	DVACS Youth Participant Questionnaire

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ICR Summary 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	8,449	8,449	0	0	0	0
Annual Time Burden (Hours)	872	872	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: 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: 08/11/2022

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