OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

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

ICR 201707-0920-003 · OMB 0920-1035 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Youth Health and Climate School Survey Form Modified Available
Att 12 Example Table Shells.docx Supplementary Document Uploaded 2017-07-10 Available
Att 11 Description of Additional Validity Checks for Study-Developed Questions.docx Supplementary Document Uploaded 2017-07-10 Available
Att 10 IRB Approval Letter.pdf Supplementary Document Uploaded 2017-07-10 Repair queued
Att 9 List of Consultants.docx Supplementary Document Uploaded 2017-07-10 Available
Att 8 Products from Previous Data Collections.docx Supplementary Document Uploaded 2017-07-10 Available
Att 7 Teacher Proctor Instructions and Script.docx Supplementary Document Uploaded 2017-07-10 Repair queued
Att 6 Letter of Agreement for Participating High Schools.docx Supplementary Document Uploaded 2017-07-10 Available
Att 5 Detailed Description of Questionnaire Revisions.docx Supplementary Document Uploaded 2017-07-10 Available
Att 4 Parental_Consent_Form.docx Supplementary Document Uploaded 2017-07-10 Available
Attachment 2A Public Comments Received.docx Supplementary Document Uploaded 2017-07-10 Available
Att 2 60-day.pdf Supplementary Document Uploaded 2017-07-10 Available
Att 1 Legis.pdf Supplementary Document Uploaded 2017-07-10 Available
SSB.docx Supporting Statement B Uploaded 2017-07-10 Available
SSA.docx Supporting Statement A Uploaded 2017-07-10 Available
IC Document Collections
IC IDCollectionTypeStatusForm
212672 Youth Health and Climate School Survey Form Modified
ICR Details
0920-1035 201707-0920-003
Historical Active 201408-0920-006
HHS/CDC 0920-1035
Assessing School-centered HIV/STD Prevention Efforts in a Local Education Agency
Revision of a currently approved collection   No
Regular
Approved without change 11/17/2017
Retrieve Notice of Action (NOA) 10/04/2017
  Inventory as of this Action Requested Previously Approved
11/30/2018 12 Months From Approved 11/30/2017
16,500 0 11,000
11,000 0 7,333
46,695 0 0
CDC requests a one year approval for revision. The information collection uses a self-administered 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. This allows the LEA to identify program strengths and areas that need improvement. Findings allow CDC to determine the impact of 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
  82 FR 17838 04/13/2017
82 FR 46061 10/03/2017
Yes
1
IC Title Form No. Form Name
Youth Health and Climate School Survey none Youth Health and School Climate 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 16,500 11,000 0 5,500 0 0
Annual Time Burden (Hours) 11,000 7,333 0 3,667 0 0
Annual Cost Burden (Dollars) 46,695 0 0 46,695 0 0
Yes
Miscellaneous Actions
No
Revision includes minor changes to the questionnaire and one additional year of data collection.
$215,609
Yes Part B of Supporting Statement
    No
    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.
10/04/2017