OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation

ICR 201009-0920-001 · OMB 0920-0816 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
SS Part B.2010.docx Supporting Statement B Uploaded 2010-08-25 Repair queued
Attach O Response to Public Comment.pdf Supplementary Document Uploaded 2010-08-25 Repair queued
Attach P Public Comment.docx Supplementary Document Uploaded 2010-08-25 Repair queued
Attach J-2 IRB Approval of Continuation of Protocol 4-28-10.doc Supplementary Document Uploaded 2010-08-25 Repair queued
Attach J-1 IRB Approval Letter REV 1-9-09 REV 4-28-10.doc Supplementary Document Uploaded 2010-08-25 Repair queued
Att B_60d FRN.pdf Supplementary Document Uploaded 2010-08-25 Available
Attach A - Section 301 of the Public Health Services Act ORIG 10-08.doc Supplementary Document Uploaded 2010-08-25 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 Available
Att.I -- Online Survey Youth Assent Form v3_final_1-26-09.doc Supplementary Document Uploaded 2009-02-02 Repair queued
SS Part A_2010.docx Supporting Statement A Uploaded 2010-08-25 Available
IC Document Collections
IC IDCollectionTypeStatusForm
188377 Focus Group Survey Other-WORD Modified
188376 Focus Group Screening Instrument for Parents and Youth Other-WORD Modified
188375 Online Screening Instrument for Youth Other-WORD Modified
188374 Online Survey Email and Online Survey Screening for Parents Other-WORD Modified
188373 Focus Group Moderator's Guide Other-WORD Modified
188372 Online Survey Other-WORD Modified
ICR Details
0920-0816 201009-0920-001
Historical Active 200903-0920-006
HHS/CDC
Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation
Revision of a currently approved collection   No
Regular
Approved without change 11/23/2010
Retrieve Notice of Action (NOA) 09/02/2010
  Inventory as of this Action Requested Previously Approved
11/30/2013 36 Months From Approved 06/30/2012
6,304 0 6,304
1,354 0 1,354
0 0 0
This Information Collection Request (ICR) is a revision of previously approved OMB# 0920-0816. This is a three year study and includes a revision to the study name from, "Youth Advice and Feedback to Inform Choose Respect Implementation" to, "Youth Knowledge, Attitudes, and Feedback to Inform Choose Respect Implementation". The proposed participants are youth, ages 1l to 18, specifically youth living in high-risk, inner-city communities (YHRICC). This research will be conducted because CDC's Division of Violence Prevention is developing an initiative to promote respectful, nonviolent dating relationships for 11- to 14-year-old YHRICC--a group that may be at an increased risk of teen dating violence (TDV) due to concentrated poverty, lack of resources, and exposure to community violence (2010a). In addition, few, if any, TDV prevention programs exist for this audience. As part of the initiative, CDC plans to engage 15- to 18-year-olds who have significant influence on their younger peers (CDC, 2010b), to help reinforce messages about healthy dating relationships. This is why 15- to 18-year-olds will also participate in the proposed information collections.
US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  75 FR 20849 04/21/2010
75 FR 38104 07/01/2010
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 6,304 6,304 0 0 0 0
Annual Time Burden (Hours) 1,354 1,354 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$568,528
Yes Part B of Supporting Statement
No
No
No
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.
09/02/2010