Information Collection Request

[NCCDPHP] Healthy Schools Program Evaluation

ICR 202504-0920-011 · OMB 0920-1455 · Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-24BJ Healthy Student Questionnaire Form Modified Available
Form 0920-24BJ Healthy Students Questionnaire Form Modified Available
Form 0920-24BJ Healthy Schools Questionnaire Form Unchanged Available
Form 0920-24BJ Healthy Schools Questionnaire Form Unchanged Missing upstream
Form 0920-24BJ Interview Guide Priority LEA Form Modified Available
Form 0920-24BJ LEA Interviews Form Modified Repair queued
Form 0920-24BJ Interview Guide Recipient Form Modified Available
Form 0920-24BJ Recipient Interviews Form Modified Available
Form 0920-24BJ Monthly Reporting Form Form Modified Repair queued
Form 0920-24BJ Monthly Reporting Form Modified Available
Change Request Memo - DASH DP-23-0002 (Clean) 2025.05.02 V4.1.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-05-13 Repair queued
Change Request Memo - DASH DP-23-0002 (Clean) 2025.05.02 V4.1.docx Justification for No Material/Nonsubstantive Change Uploaded 2025-05-13 Missing upstream
Attachment 12 - Screenshots of Healthy Student Questionnaire_updated w Race Ethnicity Q 10.31.24 (1) (002).docx Supplementary Document Uploaded 2025-01-04 Repair queued
Attachment 12 - Screenshots of Healthy Student Questionnaire_updated w Race Ethnicity Q 10.31.24 (1) (002).docx Supplementary Document Uploaded 2025-01-04 Repair queued
Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx Supplementary Document Uploaded 2025-01-04 Available
Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx Supplementary Document Uploaded 2025-01-04 Missing upstream
FRN 30 Day Text - 2302 Healthy Schools Evaluation (003).docx Supplementary Document Uploaded 2024-08-22 Repair queued
FRN 30 Day Text - 2302 Healthy Schools Evaluation (003).docx Supplementary Document Uploaded 2024-08-22 Missing upstream
Attachment 20 - 2302 Healthy Schools IRB determination letter 06-05-24.pdf Supplementary Document Uploaded 2024-08-22 Available
Attachment 20 - 2302 Healthy Schools IRB determination letter 06-05-24.pdf Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 19 - Healthy Student Questionnaire Student Assent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 19 - Healthy Student Questionnaire Student Assent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 18 - Healthy Student Questionnaire 18+ Consent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 18 - Healthy Student Questionnaire 18+ Consent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Missing upstream
Attachment 16 - Healthy Schools Questionnaire Consent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Available
Attachment 16 - Healthy Schools Questionnaire Consent Form (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 17 - Healthy Students Questionnaire Parent Consent Forms.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 17 - Healthy Students Questionnaire Parent Consent Forms.docx Supplementary Document Uploaded 2024-08-22 Available
Attachment 15 - Interview Consent Forms.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 15 - Interview Consent Forms.docx Supplementary Document Uploaded 2024-08-22 Missing upstream
Attachment 13 - Published 60 day FRN Healthy Schools.pdf Supplementary Document Uploaded 2024-08-22 Available
Attachment 13 - Published 60 day FRN Healthy Schools.pdf Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 10 - Screenshots of Healthy Schools Questionnaire (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 10 - Screenshots of Healthy Schools Questionnaire (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 12 - Screenshots of Healthy Student Questionnaire (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 12 - Screenshots of Healthy Student Questionnaire (final) 6.14.24.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 08 - Interview Invitation Email.docx Supplementary Document Uploaded 2024-08-22 Available
Attachment 08 - Interview Invitation Email.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 05 - Monthly Indicator Report Qualtrics Screenshots (EO revised) 2025.05.02.docx Supplementary Document Uploaded 2025-05-13 Available
Attachment 05 - Monthly Indicator Report Qualtrics Screenshots (EO revised) 2025.05.02.docx Supplementary Document Uploaded 2025-05-13 Repair queued
Attachment 04 - Monthly Reporting Form Email Notification.docx Supplementary Document Uploaded 2024-08-22 Available
Attachment 04 - Monthly Reporting Form Email Notification.docx Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 02 - Authorizing Legislation - Evidence-Based Policymaking Act 2018.pdf Supplementary Document Uploaded 2024-08-22 Available
Attachment 02 - Authorizing Legislation - Evidence-Based Policymaking Act 2018.pdf Supplementary Document Uploaded 2024-08-22 Repair queued
Attachment 01 - Authorizing Legislation - Public Health Service Act.pdf Supplementary Document Uploaded 2024-08-22 Available
Attachment 01 - Authorizing Legislation - Public Health Service Act.pdf Supplementary Document Uploaded 2024-08-22 Missing upstream
Healthy Schools - SSB.docx Supporting Statement B Uploaded 2024-08-22 Repair queued
Healthy Schools - SSB.docx Supporting Statement B Uploaded 2024-08-22 Repair queued
Healthy Schools - SSA (EO revised, clean) 2025.04.21.docx Supporting Statement A Uploaded 2025-05-13 Repair queued
Healthy Schools - SSA (EO revised, clean) 2025.04.21.docx Supporting Statement A Uploaded 2025-05-13 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
270338 Healthy Students Questionnaire Form ModifiedHealthy Student Questionnaire
270338 Healthy Students Questionnaire Form Modified
270336 Healthy Schools Questionnaire Form UnchangedHealthy Schools Questionnaire
270336 Healthy Schools Questionnaire Form Unchanged
270335 LEA Interviews Form ModifiedInterview Guide Priority LEA
270335 LEA Interviews Form Modified
270334 Recipient Interviews Form ModifiedInterview Guide Recipient
270334 Recipient Interviews Form Modified
270318 Monthly Reporting Form ModifiedMonthly Reporting Form
270318 Monthly Reporting Form Modified
ICR Details
0920-1455 202504-0920-011
Active 202408-0920-014
HHS/CDC 0920-25-0077
[NCCDPHP] Healthy Schools Program Evaluation
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 06/06/2025
Retrieve Notice of Action (NOA) 05/15/2025
  Inventory as of this Action Requested Previously Approved
01/31/2028 01/31/2028 01/31/2028
13,720 0 13,720
6,900 0 6,900
0 0 0

The proposed project aims to evaluate processes and outcomes of the programs of 20 state entities funded by CDC's Division of Adolescent and School Health to improve health, academic achievement, and well-being of students in K-12 schools nationwide. CDC awarded funds through cooperative agreement DP23-0002 (2302 Program) to 20 funding recipients (states, universities, and a tribal nation) to improve health, academic achievement, and well-being of students in K-12 schools. A portion of the funding within each state is allocated to one priority local education agency (LEA) and its corresponding schools to support the implementation of policies, practices, and programs to increase physical activity, healthy dietary behaviors, and management of chronic health conditions among students. CDC is conducting a mixed-methods multi-level evaluation of the 2302 Program and associated outcomes. Evaluation findings will allow CDC to help recipients improve their programs as they progress over the five-year funding period. This change request is to follow recent executive orders.

None
None

Not associated with rulemaking

  88 FR 85888 12/11/2023
89 FR 65351 08/09/2024
Yes

  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 13,720 13,720 0 0 0 0
Annual Time Burden (Hours) 6,900 6,900 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new collection requesting three years of approval for 6,900 burden hours annually.

$462,739
No
    No
    No
No
No
No
No
Kevin Joyce 404 639-1944 [email protected]

  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/15/2025