OMB control number

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

OMB 0920-1356 · HHS/CDC.

OMB 0920-1356

Latest Forms, Documents, and Supporting Material

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

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202208-0920-008	No material or nonsubstantive change to a currently approved collection	2022-08-11		Withdrawn and continue
202012-0920-010	New collection (Request for a new OMB Control Number)	2021-01-11		Approved with change