OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs

ICR 201504-0920-004 · OMB 0920-1084 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Web-basedHWC Assessment Form and Instruction New Available
Web-based CBO Assessment Form and Instruction New Available
Att 13 Example Data Analysis Table Shells.docx Supplementary Document Uploaded 2015-04-10 Available
Att 12 IRB Approval Letter.pdf Supplementary Document Uploaded 2015-04-10 Available
Att 11 Public Comment.docx Supplementary Document Uploaded 2015-04-10 Available
Att 10 List of Consultants.docx Supplementary Document Uploaded 2015-04-10 Available
Att 9 Web-based Informed Consent Form for HWC Questionnaire.docx Supplementary Document Uploaded 2015-04-10 Available
Att 8 Web-based Informed Consent Form for CBO Questionnaire.docx Supplementary Document Uploaded 2015-04-10 Available
Att 4 DASH YMSM HWC Assessment.docx Supplementary Document Uploaded 2015-04-10 Available
Att 7 Introductory Email.docx Supplementary Document Uploaded 2015-04-10 Available
Att 3 DASH YMSM CBO Assessment.docx Supplementary Document Uploaded 2015-04-10 Available
Att 2 60-day FRN.pdf Supplementary Document Uploaded 2015-04-10 Available
Att 1 Public Health Service Act Legislation.pdf Supplementary Document Uploaded 2015-04-10 Available
SSB 31AUG2015.docx Supporting Statement B Uploaded 2015-09-08 Available
SSA 31AUG2015.docx Supporting Statement A Uploaded 2015-09-08 Available
IC Document Collections
IC IDCollectionTypeStatusForm
216051 Web-basedHWC Assessment Form and Instruction New
216050 Web-based CBO Assessment Form and Instruction New
ICR Details
0920-1084 201504-0920-004
Historical Active
HHS/CDC 15KX
Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 09/11/2015
Retrieve Notice of Action (NOA) 04/28/2015
  Inventory as of this Action Requested Previously Approved
09/30/2018 36 Months From Approved
60 0 0
60 0 0
0 0 0
The CDC requests a 3-year OMB approval to conduct a new information collection (IC) entitled, "Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs." The IC uses two versions of a self-administered web-based questionnaire --the Community-based organization (CBO) Assessment Questionnaire and the Health and/or Wellness Center (HWC) Assessment Questionnaire --to conduct an in-depth assessment with staff from CBOs and HWCs, which include school wellness centers and school-based health centers. The assessment will ask about partnerships and HIV and STD prevention efforts that are taking place in conjunction with the three local education agencies (LEAs) funded by the CDC, Division of Adolescent and School Health (DASH) under strategy 4 (School-Centered HIV/STD Prevention for Young MSM) of PS13-1308: Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  80 FR 3238 01/22/2015
80 FR 22192 04/21/2015
Yes
2
IC Title Form No. Form Name
Web-based CBO Assessment None District Partner Assessment - CBO
Web-basedHWC Assessment None District Partner Assessment - HWC
  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 60 0 0 60 0 0
Annual Time Burden (Hours) 60 0 0 60 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
0920-15KX is a New ICR
$45,739
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 [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.
04/28/2015