[NCIPC] Formative Research on Adverse and Positive Childhood Experiences, Social Determinants of Health, and Health Equity Among Young Adults in the US

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Web Survey – Spanish	Form and Instruction	New	Missing upstream
Web Survey – English	Form and Instruction	New	Repair queued
Att I Recruitment Advertisement.docx	Supplementary Document	Uploaded 2024-12-13	Repair queued
Att D IRB Approval_English Survey.pdf	Supplementary Document	Uploaded 2024-12-13	Repair queued
Att C Privacy Impact.pdf	Supplementary Document	Uploaded 2024-12-13	Missing upstream
Att B 60 Dy FRN.pdf	Supplementary Document	Uploaded 2024-12-13	Missing upstream
Att A Regulation and BILLS-116hr7689ih.pdf	Supplementary Document	Uploaded 2024-12-13	Missing upstream
FRAPCE_SSB__9.6.24.docx	Supporting Statement B	Uploaded 2024-12-13	Repair queued
FRAPCE_SSA_19Sept2024_final.docx	Supporting Statement A	Uploaded 2024-12-13	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
273025	Web Survey – Spanish	Form and Instruction	New
273024	Web Survey – English	Form and Instruction	New
273023	Follow up Recruitment Email	Other-Email	New
273022	Recruitment Email	Other-Email	New

ICR Details

OMB Control No:	ICR Reference No: 202412-0920-005
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-24GO
Title: [NCIPC] Formative Research on Adverse and Positive Childhood Experiences, Social Determinants of Health, and Health Equity Among Young Adults 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	Date Submitted to OIRA: 12/19/2024

table that charts list comparision

	Requested	Previously Approved
Expiration Date	12 Months From Approved
Responses	41,443	0
Time Burden (Hours)	3,591	0
Cost Burden (Dollars)	0	0

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Abstract: The goal of this collection is to conduct formative research to 1) advance the field's understanding of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) among populations that have been inequitably impacted by ACEs; 2) contribute to greater clarity and precision in measuring ACEs and PCEs; and 3) inform future research on the relationship between ACEs, social determinants of health (SDOH), and health outcomes.

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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:
	89 FR 58739	07/19/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 101015	12/13/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Follow up Recruitment Email
Recruitment Email
Web Survey – English	n/a	FRAPCE-Formative Research on Adverse & Positive Childhood Experiences Questionnaire
Web Survey – Spanish	n/a	FRAPCE-Formative Research on Adverse & Positive Childhood Experiences Questionnaire Spanish

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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	41,443	0	0	41,443	0	0
Annual Time Burden (Hours)	3,591	0	0	3,591	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 Collection. FR is actually 101015 but ROCIS only allows 5 digits currently

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Annual Cost to Federal Government: $1,124,868

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.     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

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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: 12/19/2024

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