OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Responding to Intimate Violence in Relationship Programs (RIViR)

ICR 201611-0970-002 · OMB 0970-0503 · Historical Inactive

Forms and Documents
DocumentTypeStatusAvailability
RIViR_OMB_Refs_Nov_2_2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_E.1_IRB Approval Notice.pdf Supplementary Document Uploaded 2016-11-09 Available
Att_D.1_Existing validated IPV and TDV screening tools_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Available
Att_B.8_Youth over 18_consent_script_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Available
Att_B.7_Youth over 18_consent_form_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_B.6_Youth_assent_script_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_B.5_Youth_assent_form_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Available
Att_B.4_Parent permission_script_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_B.3_Parent permission_form_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_B.2_Adult_consent_script_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_B.1_Adult_consent_form_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_A.3_Recruitment script for youth 18+_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_A.2_Recruitment script for adults_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Repair queued
Att_A.1_Lead letter for parents_Oct 10 2016.docx Supplementary Document Uploaded 2016-11-09 Available
RIViR_OMB_SSB_Oct 10 2016.doc Supporting Statement B Uploaded 2016-11-09 Available
RIViR_OMB_SSA_Nov 3 2016_final.docx Supporting Statement A Uploaded 2016-11-09 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
224373 Administration of data collection protocol and record-keeping Other-Staff involvement in data collection New
224372 Participant recruitment Other-Recruitment Efforts New
224371 Post screener questions for youth (C.3) Other-Post Screener Questions New
224370 Post screener questions for adults (C.3) Other-Post Screener Questions New
224369 Contact information form for parents of youth younger than 18 (C.2) Other-Contact Info New
224368 Locator section for adults (C.1) Other-Location section New
224367 2.3: TDV Screener 3 Other-Screener New
224366 2.2: TDV Screener 2 Other-Screener New
224365 2.1: TDV Screener 1 Other-Screener New
224364 1.3: IPV Screener 3 Other-Screener New
224363 1.2: IPV Screener 2 Other-Screener New
224362 1.1: IPV Screener 1 Other-Screener New
ICR Details
0970-0503 201611-0970-002
Historical Inactive
HHS/ACF
Responding to Intimate Violence in Relationship Programs (RIViR)
New collection (Request for a new OMB Control Number)   No
Regular
Withdrawn 06/28/2017
Retrieve Notice of Action (NOA) 11/14/2016
  Inventory as of this Action Requested Previously Approved
24 Months From Approved
0 0 0
0 0 0
0 0 0
The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval for data collection as a component of the Responding to Intimate Violence in Relationship Programs (RIVIR) project. The goals of this research project are to develop improved theoretical frameworks, screening tools, and surrounding protocols for recognizing and addressing intimate partner violence (IPV) and teen dating violence (TDV) in healthy marriage and relationship education (HMRE) programs with the diverse, middle- to low-income populations they serve. We are studying HMRE programs, and we are referring to them as “healthy relationship” (HR) programs in this project (and consequently throughout this document). This project has already conducted several activities using existing data sources and materials to synthesize information about the current state of the field and to identify potential IPV and TDV screeners and protocols. The project is now planning to test these IPV and TDV screeners and surrounding protocols in HR programs. This Information Collection Request seeks approval for this testing component of the RIVIR project. We plan to test standardized quantitative tools, as well as open-ended scripts that create opportunities for disclosure of IPV or TDV among adults and youth who participate in HR programs. This work will include data collection from approximately 1,200 HR program participants and will be completed in collaboration with approximately four HR grantee organizations funded by ACF’s Office of Family Assistance (OFA) to implement HR programs.
None
None
Not associated with rulemaking
  81 FR 21553 04/12/2016
81 FR 78835 11/09/2016
No
Yes
Miscellaneous Actions
No
This is a new data collection.
$430,000
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Molly Buck 202 205-4724 [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.
11/14/2016