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 202205-0920-011 · OMB 0920-1351 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-20PJ Community Leaders or Service Providers Form and Instruction Unchanged Available
Form 0920-20PJ Parents, Caregivers, and Young Adults Form and Instruction Unchanged Repair queued
Form 0920-20PJ Tribal Elders/Tribal Leaders/Traditional Healers Form and Instruction Unchanged Available
Form 0920-1351 Demographic Survey Form and Instruction Modified Repair queued
Form 0920-20PJ Informed Consent Form and Instruction Unchanged Repair queued
Form 0920-20PJ Telephone Screening Form and Instruction Unchanged Repair queued
BIRCH Changes to Attachment I Demographic Survey 5-12-2022.docx Supplementary Document Uploaded 2022-05-26 Repair queued
BIRCH Crosswalk Template Non Substantive OMB Changes 5-12-2022.xlsx Supplementary Document Uploaded 2022-05-25 Repair queued
BIRCH Change Request Memo OMB 0920-1351 5-12-2022.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-05-25 Repair queued
Attachment O_Study Flyer.docx Supplementary Document Uploaded 2021-05-11 Available
Attachment N_IRB Letter.pdf Supplementary Document Uploaded 2021-05-11 Missing upstream
Attachment M_ PIA.pdf Supplementary Document Uploaded 2021-05-11 Missing upstream
Attachment H List of local and national resources for participants.docx Supplementary Document Uploaded 2021-05-11 Repair queued
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 Missing upstream
SSA Formative Research Tribal Communities_final.docx Supporting Statement A Uploaded 2021-05-11 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
247307 Community Leaders or Service Providers Form and Instruction Unchanged
247306 Parents, Caregivers, and Young Adults Form and Instruction Unchanged
247305 Tribal Elders/Tribal Leaders/Traditional Healers Form and Instruction Unchanged
247304 Demographic Survey Form and Instruction Modified
247303 Informed Consent Form and Instruction Unchanged
247302 Reminder Email/Letter Other-Letter Unchanged
247301 Confirmatin Email/Letter Other-Letter Unchanged
247300 Telephone Screening Form and Instruction Unchanged
247298 Informational Letter Other-Letter Unchanged
ICR Details
0920-1351 202205-0920-011
Received in OIRA 202105-0920-002
HHS/CDC 0920-1351-22FR
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
No material or nonsubstantive change to a currently approved collection   No
Regular 05/26/2022
  Requested Previously Approved
10/31/2024 10/31/2024
920 920
441 441
0 0
This is a request for non-substantive changes to the demographic survey related to the feedback received from the tribal communities engaged in the research study. The changes are outlined below and in Attachment I. Note that the request does not include changes to the currently approved burden and/or costs.
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 920 920 0 0 0 0
Annual Time Burden (Hours) 441 441 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$651,396
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
No
Thelma Sims 4046394771
  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.
05/26/2022