OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"

ICR 201304-0920-002 · OMB 0920-0952 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form no National Organization Training and Technical Assistance Reporting Form Form Modified Available
Form no State and Community Awardee Training and Technical Assistance Reporting Form Form Modified Available
State and Community Awardee Staff Needs Assessment Form Modified Repair queued
State and Community Awardee Project Director/Project Coordinator Needs Assessment Form Modified Repair queued
State and Community Awardee Performance Measure Reporting Tool Form and Instruction Modified Available
Community and Clinical Partner Program Implementation Partner Needs Assessment Form and Instruction Modified Repair queued
Community and Clinical Partner Clinical Partner Needs Assessment Form and Instruction Modified Available
0920-0952 Change Request Justification 01APR13.docx Justification for No Material/Nonsubstantive Change Uploaded 2013-04-02 Available
Attachment 8 (rev) State and Community Awardee Staff Needs Assessment.docx Supplementary Document Uploaded 2013-04-02 Repair queued
Attachment 7 (rev) State and Community Awardee Project Coordinator Project Director Needs Assessment.docx Supplementary Document Uploaded 2013-04-02 Available
Att 11. Description of Assessment Tools.docx Supplementary Document Uploaded 2012-09-04 Available
Att 12. Clinical Component Best Practices.docx Supplementary Document Uploaded 2012-09-04 Available
IC Document Collections
IC IDCollectionTypeStatusForm
203977 National Organization Training and Technical Assistance Reporting Form Form Modified
203976 State and Community Awardee Training and Technical Assistance Reporting Form Form Modified
203975 State and Community Awardee Staff Needs Assessment Form Modified
203974 State and Community Awardee Project Director/Project Coordinator Needs Assessment Form Modified
203973 State and Community Awardee Performance Measure Reporting Tool Form and Instruction Modified
203972 Community and Clinical Partner Program Implementation Partner Needs Assessment Form and Instruction Modified
203971 Community and Clinical Partner Clinical Partner Needs Assessment Form and Instruction Modified
ICR Details
0920-0952 201304-0920-002
Historical Active 201209-0920-003
HHS/CDC 19224
Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 04/03/2013
Retrieve Notice of Action (NOA) 04/02/2013
  Inventory as of this Action Requested Previously Approved
12/31/2015 12/31/2015 12/31/2015
1,039 0 1,039
1,150 0 1,150
0 0 0
CDC is seeking approval for web-based collection of this process evaluation. CDC plans to collect the information needed to conduct a process and intermediate outcome evaluation of community-wide teen pregnancy prevention efforts involving nine state and community awardees, and five national organizations.
PL: Pub.L. 111 - 117 D Name of Law: Consolidated Appropriations Act of 2012
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
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 1,039 1,039 0 0 0 0
Annual Time Burden (Hours) 1,150 1,150 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$462,427
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Carol Walker 4046394773
  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.
04/02/2013