OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency

ICR 201408-0920-006 · OMB 0920-1035 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Youth Health and Climate School Survey Form New Available
Att 11 Description of Additional Validity Checks for Study-Developed Questions.docx Supplementary Document Uploaded 2014-11-05 Available
Att 10 Teacher Proctor Instructions and Script.docx Supplementary Document Uploaded 2014-11-05 Available
Att 9 Letter of Agreement for Participating High Schools.docx Supplementary Document Uploaded 2014-11-05 Available
Att 7 Example Table Shells.docx Supplementary Document Uploaded 2014-08-14 Available
Att 6 IRB Approval 2014-08-11.docx Supplementary Document Uploaded 2014-08-14 Available
Att 5 List of Consultants.docx Supplementary Document Uploaded 2014-08-14 Repair queued
Att 4 Passive_Parental_Consent_Form_with_Translations.docx Supplementary Document Uploaded 2014-11-05 Available
Att 8 Public Comments on 60-day FRN.pdf Supplementary Document Uploaded 2014-08-14 Repair queued
Att 2 60 Day FRN.pdf Supplementary Document Uploaded 2014-08-14 Available
Att 1 Legis.pdf Supplementary Document Uploaded 2014-08-14 Available
SSB 2014-11-04_clean.docx Supporting Statement B Uploaded 2014-11-05 Available
SSA_2014-11-04_clean.docx Supporting Statement A Uploaded 2014-11-05 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
212672 Youth Health and Climate School Survey Form New
ICR Details
0920-1035 201408-0920-006
Historical Active
HHS/CDC 14YI
Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/07/2014
Retrieve Notice of Action (NOA) 09/12/2014
  Inventory as of this Action Requested Previously Approved
11/30/2017 36 Months From Approved
11,000 0 0
7,333 0 0
0 0 0
The information collection uses a self-administered paper-pencil questionnaire, the Youth Health and School Climate Survey, to assess HIV and STD prevention efforts in one local education agency (LEA) funded by CDC Division of Adolescent and School Health under cooperative agreement PS13-1308. This will allow the LEA to identify program strengths and areas that need improvement. Findings will allow CDC to determine the impact of currently recommended strategies and change recommendations if necessary. The questionnaire includes questions on demographics, HIV and STD risk behaviors, use of related health services, school experiences including connectedness, harassment and bullying, homophobia, support of LGBTQ students, receipt of referral for HIV and STD prevention health services, and health education.
US Code: 42 USC 301 Name of Law: PHSA
  
None
Not associated with rulemaking
  79 FR 27615 05/14/2014
79 FR 50651 08/25/2014
Yes
1
IC Title Form No. Form Name
Youth Health and Climate School Survey none Youth Health and Climate School Survey
  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 11,000 0 0 11,000 0 0
Annual Time Burden (Hours) 7,333 0 0 7,333 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.
$299,130
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]
  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.
09/12/2014