OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Youth Advice and Feedback to Inform Choose Respect Implementation

ICR 200903-0920-006 · OMB 0920-0816 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Att N_--_Focus_Group_Survey_REV 6 17 09.doc Supplementary Document Uploaded 2009-06-19 Available
Att M_--_Focus_Group_Screening_Instrument_for_Parents_and_Youth REV 6 17 09.doc Supplementary Document Uploaded 2009-06-19 Repair queued
Att L_--_Youth_Assent_Form_for_Focus_Groups_REV_6 17 09.doc Supplementary Document Uploaded 2009-06-19 Repair queued
Att F_--_Online_Survey_Screening_Instrument_for_Parents_REV_6 17 09.doc Supplementary Document Uploaded 2009-06-19 Repair queued
Att D_--_Focus_Group_Moderator's_Guide_REV 6 17 09.doc Supplementary Document Uploaded 2009-06-19 Repair queued
Att C_--_Online_Survey_v2_REV_6 17 09.doc Supplementary Document Uploaded 2009-06-19 Repair queued
Att N_--_Focus_Group_Survey_REV 6 17 09.doc Supplementary Document Uploaded 2009-06-18 Repair queued
Att M_--_Focus_Group_Screening_Instrument_for_Parents_and_Youth REV 6 17 09.doc Supplementary Document Uploaded 2009-06-18 Available
Att L_--_Youth_Assent_Form_for_Focus_Groups_REV_6 17 09.doc Supplementary Document Uploaded 2009-06-18 Repair queued
Att F_--_Online_Survey_Screening_Instrument_for_Parents_REV_6 17 09.doc Supplementary Document Uploaded 2009-06-18 Repair queued
Att D_--_Focus_Group_Moderator's_Guide_REV 6 17 09.doc Supplementary Document Uploaded 2009-06-18 Repair queued
Att C_--_Online_Survey_v2_REV_6 17 09.doc Supplementary Document Uploaded 2009-06-18 Repair queued
SS_Part B_final_1-26-09.doc Supporting Statement B Uploaded 2009-02-02 Available
Att.J -- IRB Approval Letter_final 1-26-09.doc Supplementary Document Uploaded 2009-02-02 Repair queued
Att.O -- FW public comment on federal register of 21208 vol 73 #29 pg 8045 dhs cdc 08AP.htm Supplementary Document Uploaded 2009-02-02 Available
Att.B -- 60d FRN.pdf Supplementary Document Uploaded 2009-02-02 Available
Att.A -- Section 301 of the Public Health Services Act.doc Supplementary Document Uploaded 2009-02-02 Available
Att.K -- Parental Permission Form for Focus Groups_final_ 1-26-09.doc Supplementary Document Uploaded 2009-02-02 Repair queued
Att.L -- Youth Assent Form for Focus Groups_REV 1-9-09.doc Supplementary Document Uploaded 2009-02-02 Repair queued
Att.I -- Online Survey Youth Assent Form v3_final_1-26-09.doc Supplementary Document Uploaded 2009-02-02 Available
Att.E -- Onilne Survey Email Invitation_final_1-26-09.doc Supplementary Document Uploaded 2009-02-02 Available
Att.G_ Online Survey Parental Permission Form._1-26-09.doc Supplementary Document Uploaded 2009-02-02 Repair queued
SS_Part_A_final_REV 6 17 09.doc Supporting Statement A Uploaded 2009-06-19 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
188377 Focus Group Survey Other-WORD New
188376 Focus Group Screening Instrument for Parents and Youth Other-WORD New
188375 Online Screening Instrument for Youth Other-WORD New
188374 Online Survey Email and Online Survey Screening for Parents Other-WORD New
188373 Focus Group Moderator's Guide Other-WORD New
188372 Online Survey Other-WORD New
ICR Details
0920-0816 200903-0920-006
Historical Active
HHS/CDC
Youth Advice and Feedback to Inform Choose Respect Implementation
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 06/26/2009
Retrieve Notice of Action (NOA) 03/10/2009
Approved consistent with modifications uploaded on 6/19/2009.
  Inventory as of this Action Requested Previously Approved
06/30/2012 36 Months From Approved
6,304 0 0
1,354 0 0
0 0 0
Psychological and physical abuse occurs in as many as one in three adolescent dating relationships. The Centers for Disease Control and Prevention (CDC) has included among its top research priorities efforts to prevent intimate partner violence. In 2006, it's National Center for Injury Prevention and Control introduced the Choose Respect initiative to help 11- to 14-year olds to form health relationships to prevent dating abuse. The initiative is designed to encourage youth to treat themselves and other with respect; increase their ability to recognize/prevent unhealthy relationships; and promote access of prevention information/tools. CDC is seeking to conduct audience research to test creative concepts/messages/ materials and planned communication strategies/tactics. Feedback will be used to revise/enhance campaign implementation and ensure that it effectively reaches its audience.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  73 FR 8045 02/12/2008
74 FR 6161 02/05/2009
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 6,304 0 0 6,304 0 0
Annual Time Burden (Hours) 1,354 0 0 1,354 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new information collection request.
$384,665
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
Uncollected
Thelma Sims 4046394771
  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.
03/10/2009