OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Formative Research on Community-Level Factors that Promote the Primary Prevention of Adverse Childhood Experiences (ACEs) and Opioid Misuse Among Children, Youth, and Families in Tribal American India

ICR 202105-0920-002 · OMB 0920-1351 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-20PJ Community Leaders or Service Providers Form and Instruction New Missing upstream
Form 0920-20PJ Parents, Caregivers, and Young Adults Form and Instruction New Repair queued
Form 0920-20PJ Tribal Elders/Tribal Leaders/Traditional Healers Form and Instruction New Repair queued
Form 0920-20PJ Demographic Survey Form and Instruction New Repair queued
Form 0920-20PJ Informed Consent Form and Instruction New Repair queued
Form 0920-20PJ Telephone Screening Form and Instruction New Repair queued
Attachment O_Study Flyer.docx Supplementary Document Uploaded 2021-05-11 Missing upstream
Attachment N_IRB Letter.pdf Supplementary Document Uploaded 2021-05-11 Missing upstream
Attachment M_ PIA.pdf Supplementary Document Uploaded 2021-05-11 Available
Attachment H List of local and national resources for participants.docx Supplementary Document Uploaded 2021-05-11 Missing upstream
Attachment B_ Federal Register Notice.pdf Supplementary Document Uploaded 2021-05-11 Repair queued
Attachment A_ Authorizing Legislation.docx Supplementary Document Uploaded 2021-05-11 Repair queued
SSB Formative Research Tribal Communities_final.docx Supporting Statement B Uploaded 2021-05-11 Repair queued
SSA Formative Research Tribal Communities_final.docx Supporting Statement A Uploaded 2021-05-11 Missing upstream
IC Document Collections
IC IDCollectionTypeStatusForm
247307 Community Leaders or Service Providers Form and Instruction New
247306 Parents, Caregivers, and Young Adults Form and Instruction New
247305 Tribal Elders/Tribal Leaders/Traditional Healers Form and Instruction New
247304 Demographic Survey Form and Instruction New
247303 Informed Consent Form and Instruction New
247302 Reminder Email/Letter Other-Letter New
247301 Confirmatin Email/Letter Other-Letter New
247300 Telephone Screening Form and Instruction New
247298 Informational Letter Other-Letter New
ICR Details
202105-0920-002
Received in OIRA
HHS/CDC 0920-20PJ
Formative Research on Community-Level Factors that Promote the Primary Prevention of Adverse Childhood Experiences (ACEs) and Opioid Misuse Among Children, Youth, and Families in Tribal American India
New collection (Request for a new OMB Control Number)   No
Regular 05/14/2021
  Requested Previously Approved
36 Months From Approved
920 0
441 0
0 0
The goal of this Information Collection Request (ICR) is to conduct formative qualitative studies to identify community-level protective factors (e.g., intergenerational connection to Tribal Elders) and primary prevention strategies across a range of Tribal communities (i.e., urban and rural/reservation) to prevent adverse childhood experiences (ACEs) and opioid misuse.
US Code: 42 USC 241 Name of Law: PHSA
  
None
Not associated with rulemaking
  85 FR 128 07/02/2020
86 FR 26519 05/14/2021
Yes
  Total Request 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 920 0 0 920 0 0
Annual Time Burden (Hours) 441 0 0 441 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a New Collection.
$651,396
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
No
Kevin Joyce 404 639-1944 [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.
05/14/2021