OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Responding to Intimate Violence in Relationship Programs (RIViR)

ICR 201710-0970-007 · OMB 0970-0503 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
RIViR_OMB_SSB_Oct 12 2017_clean.doc Supporting Statement B Uploaded 2017-10-16 Available
RIVIR SSA_11 3 17_clean final.docx Supporting Statement A Uploaded 2017-11-03 Available
RIViR OMB Resubmission Memo_Oct 12 2017.docx Supplementary Document Uploaded 2017-10-16 Available
Att_B.4s_Parent permission_script_9-26-17_SPANISH.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_B.3s_Parent permission_form_9-26-17_SPANISH.docx Supplementary Document Uploaded 2017-10-16 Available
References_Oct 13 2017.docx Supplementary Document Uploaded 2017-10-16 Available
Att_F.1_IRB Approval Notice_renewed.pdf Supplementary Document Uploaded 2017-10-16 Available
Att_D.1_Existing IPV & TDV measures_7-18-17_clean.docx Supplementary Document Uploaded 2017-10-16 Available
Att_B.8_Youth over 18_consent script_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_B.7_Youth over 18_consent form_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Available
Att_B.6_Youth assent script_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Available
Att_B.5_Youth assent form_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_B.4_Parent permission script_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_B.3_Parent permission form_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_B.2_Adult consent script_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_B.2_Adult consent script_9-26-17_clean.docx Supplementary Document Uploaded 2017-10-16 Repair queued
Att_A.3_Recruitment script for youth 18+_9-7-17_clean.docx Supplementary Document Uploaded 2017-10-16 Available
Att_A.2_Recruitment script for adults_6-9-17_clean.docx Supplementary Document Uploaded 2017-10-16 Available
Att_A.1_Lead letter for parents_9-7-17_clean.docx Supplementary Document Uploaded 2017-10-16 Available
IC Document Collections
IC IDCollectionTypeStatusForm
224373 Administration of data collection protocol and record-keeping Other-Staff involvement in data collection Unchanged
224372 Participant recruitment Other-Recruitment Efforts Unchanged
224371 Contact information form for parents of youth younger than 18 (C.3) Other-Contact Form Modified
224370 Locator section for adults (C.2) Other-Locator Section Modified
224369 Post screener questions for youth (C.1) Other-Post Screener Modified
224368 Post screener questions for adults (C.1) Other-Post Screener Modified
224367 2.3: TDV Screener 3 Other-Screener Modified
224366 2.2: TDV Screener 2 Other-Screener Modified
224365 2.1: TDV Screener 1 Other-Screener Modified
224364 1.3: IPV Screener 3 Other-Screener Modified
224363 1.2: IPV Screener 2 Other-Screener Modified
224362 1.1: IPV Screener 1 Other-Screener Modified
ICR Details
0970-0503 201710-0970-007
Historical Active 201611-0970-002
HHS/ACF
Responding to Intimate Violence in Relationship Programs (RIViR)
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 11/08/2017
Retrieve Notice of Action (NOA) 10/16/2017
  Inventory as of this Action Requested Previously Approved
11/30/2020 36 Months From Approved
3,600 0 0
550 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.
PL: Pub.L. 74 - 271 403(a)(2) Name of Law: Social Security Act as amended by the Welfare Integrity and Data Improvement Act of FY12
  
None
Not associated with rulemaking
  81 FR 21553 04/12/2016
81 FR 78835 11/09/2016
No
  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 3,600 0 0 3,600 0 0
Annual Time Burden (Hours) 550 0 0 550 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new information collection.
$430,000
Yes Part B of Supporting Statement
    Yes
    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.
10/16/2017