Promoting Adolescent Health through School-Based HIV Prevention

OMB 0920-1275

The purpose of this request is to obtain a three-year approval for data collection using a Web-based program evaluation and monitoring system, the Program Evaluation and Reporting System (PERS), that will use questionnaires to allow the Division of Adolescent and School Health, (DASH) at the Centers for Disease Control and Prevention (CDC) to organize, plan, and track activities conducted by funded Local Education Agencies (LEAs) under NOFO PS18-1807 Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance.

The latest form for Promoting Adolescent Health through School-Based HIV Prevention expires 2022-11-30 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
District Assistance Questionnaire Form and Instruction
Priority School Questionnaire Form and Instruction
Funded District Questionnaire Form and Instruction
Att13 PIA.pdf Supplementary Document
Att12-SCDC ASTDR IRB Determination.docx Supplementary Document
Att11-CDC Program Eval Framework.docx Supplementary Document
Att10-Analysis of Alternatives.docx Supplementary Document
Att9c-SSE Rationale.docx Supplementary Document
Att9b-SHS Rationale.docx Supplementary Document
Att9a-SHE Rationale.docx Supplementary Document
Att7-LEAs Providing Feedback.docx Supplementary Document
Att6-List of Funded LEAs.docx Supplementary Document
Att2a-60 Day FRN Public Comments.docx Supplementary Document
Att2_60-day_FRN Published 4-8-2022.pdf Supplementary Document
Att1-Authorizing Legislation.docx Supplementary Document
SSB_PERS.docx Supporting Statement B
SSA_PERS_09162022.docx Supporting Statement A
District Assistance Questionnaire Form and Instruction
Priority School Questionnaire Form and Instruction
Funded District Questionnaire Form and Instruction

All Historical Document Collections

202209-0920-014 Approved without change	Extension without change of a currently approved collection	2022-09-30
201908-0920-010 Approved with change	New collection (Request for a new OMB Control Number)	2019-09-11

OMB Details

Funded District Questionnaire

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-19AUK

Funded District Questionnaire

Fillable Fileable

Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.