OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Randomized Controlled Trial for Routine Screening for Intimate Partner Violence

ICR 200812-0920-002 · OMB 0920-0761 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Pretest Followup Form and Instruction Modified Available
Pretest Baseline Form and Instruction Modified Available
Main Study Followup Form and Instruction Modified Available
Main Study Baseline Form and Instruction Modified Repair queued
Eligibility Screening for Pretest and Main Study Form and Instruction Modified Available
incentives & participation rates.htm.pdf Supplementary Document Uploaded 2008-12-04 Available
REQUEST FOR CHANGES.doc Justification for No Material/Nonsubstantive Change Uploaded 2008-12-04 Available
Attachment D Informed Consent for Pretest.doc Supplementary Document Uploaded 2007-07-17 Available
Attachment E Informed Consent for Main Study.doc Supplementary Document Uploaded 2007-07-17 Available
IC Document Collections
IC IDCollectionTypeStatusForm
181532 Pretest Followup Form and Instruction Modified
181531 Pretest Baseline Form and Instruction Modified
181530 Main Study Followup Form and Instruction Modified
181529 Main Study Baseline Form and Instruction Modified
181528 Eligibility Screening for Pretest and Main Study Form and Instruction Modified
ICR Details
0920-0761 200812-0920-002
Historical Active 200708-0920-001
HHS/CDC
Randomized Controlled Trial for Routine Screening for Intimate Partner Violence
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 01/22/2009
Retrieve Notice of Action (NOA) 12/10/2008
  Inventory as of this Action Requested Previously Approved
01/31/2011 01/31/2011 01/31/2011
3,814 0 3,814
718 0 718
0 0 0
Intimate partner violence (IPV) occurs frequently and has serious health, economic, and social consequences. Given the seriousness of this problem, numerous professional and health care organizations have recommended routine screening of women for IPV by health care providers in primary care settings. We propose a randomized controlled trial that will recruit 3680 women in a public obsetrics, gynecology, and family planning clinic. Women attending this clinic tend to be African American and of lower socioeconomic status. For this study (the Main Study), women will be randomly allocated to one of three arms: 1) screened for IPV, and if disclosing IPV, provided information on available IPV services; 2) not screened and all receiving information on available IPV services; or 3) a control group that will not be screened nor receive information on available IPV services.
US Code: 42 USC 301 Name of Law: Public Health Service Act Research and Investigation General
   US Code: 42 USC 391 Name of Law: Public Health Service Act Prevention and Control of Injuries
  
None
Not associated with rulemaking
  71 FR 42644 07/27/2006
72 FR 38837 07/13/2007
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 3,814 3,814 0 0 0 0
Annual Time Burden (Hours) 718 718 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$482,067
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
Uncollected
Uncollected
Maryam Daneshvar 4046394604
  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.
12/10/2008