OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Randomized Controlled Trial for Routine Screening for Intimate Partner Violence

ICR 201003-0920-008 · OMB 0920-0761 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form no number Eligibility Script for Main Study Form New Available
Form no number Pretest Followup Form Modified Available
Form no number Follow-up Questionnaire Main Study Form Modified Available
Form no number Baseline Questionnaire Main Study Form Modified Available
Form no number Baseline Questionnaire Form Modified Available
Form no number Eligibility Script for Pretest Form Modified Available
ATTACHMENT G-QOL SF-12 Spanish.doc Supplementary Document Uploaded 2010-04-16 Available
OMB SUPP STMT Part B revision-09.doc Supporting Statement B Uploaded 2010-02-25 Available
Attachment G.pdf Supplementary Document Uploaded 2010-03-01 Available
ATTACHMENT H - public comment.docx Supplementary Document Uploaded 2010-02-25 Available
ATTACHMENT D - IRB Continuation Approval.doc Supplementary Document Uploaded 2010-02-25 Available
ATTACHMENT C.docx Supplementary Document Uploaded 2010-02-25 Available
Published 60 day page 2.pdf Supplementary Document Uploaded 2010-02-25 Available
Published 60 day page 1.pdf Supplementary Document Uploaded 2010-02-25 Repair queued
ATTACHMENT A.docx Supplementary Document Uploaded 2010-02-25 Available
OMB SUPP STMT Part A 2_11_10.docx Supporting Statement A Uploaded 2010-03-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
192297 Eligibility Script for Main Study Form New
181532 Pretest Followup Form Modified
181531 Follow-up Questionnaire Main Study Form Modified
181530 Baseline Questionnaire Main Study Form Modified
181529 Baseline Questionnaire Form Modified
181528 Eligibility Script for Pretest Form Modified
ICR Details
0920-0761 201003-0920-008
Historical Active 200812-0920-002
HHS/CDC
Randomized Controlled Trial for Routine Screening for Intimate Partner Violence
Revision of a currently approved collection   No
Regular
Approved with change 04/26/2010
Retrieve Notice of Action (NOA) 03/17/2010
  Inventory as of this Action Requested Previously Approved
04/30/2013 36 Months From Approved 01/31/2011
1,753 0 3,814
308 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. The Centers for Disease Control and Prevention (CDC) is requesting approval of revisions resulting from findings after conducting the Pretest.
US Code: 42 USC 391 Name of Law: Public Health Service Act Prevention and Control of Injuries
   US Code: 42 USC 301 Name of Law: Public Health Service Act Research and Investigation General
  
None
Not associated with rulemaking
  74 FR 66976 12/17/2009
75 FR 8955 02/26/2010
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 1,753 3,814 0 -2,061 0 0
Annual Time Burden (Hours) 308 718 0 -410 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
Yes
Miscellaneous Actions
The proposed changes are based on findings from the Pretest that showed high number of Spanish speakers at recruitment clinics, a higher prevalence of reported exposure to intimate partner violence, and redundancy of the 20-item mental health scale with other measures being used. This revision results in a reduction of burden hours.
$475,556
Yes Part B of Supporting Statement
No
Uncollected
Uncollected
No
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.
03/17/2010