OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US

ICR 202208-0920-008 · OMB 0920-1356 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-22HW Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire Form and Instruction Modified Repair queued
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Consent/Assent Form and Instruction Unchanged Repair queued
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Household Questionnaire Form and Instruction Unchanged Missing upstream
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Houehold Consent Form and Instruction Unchanged Missing upstream
Form 0920-22HW Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire Form and Instruction Modified Repair queued
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter Form Unchanged Repair queued
Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol Form and Instruction Unchanged Repair queued
Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent Form and Instruction Unchanged Repair queued
Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent Form and Instruction Unchanged Repair queued
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening Form and Instruction Unchanged Repair queued
Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry Form and Instruction Unchanged Missing upstream
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening Form and Instruction Unchanged Repair queued
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry Form and Instruction Unchanged Repair queued
Attachment X_Cognitive Interview Report Final.docx Supplementary Document Uploaded 2022-08-10 Available
OMB_Change_Request_DVACS_Pilot_7 22 22.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-08-10 Missing upstream
Attachment K_Screenshots.pdf Supplementary Document Uploaded 2021-12-03 Repair queued
Attachment P_VACS Adaptation Expert Consultation Report_July 2017.pdf Supplementary Document Uploaded 2021-12-03 Repair queued
Attachment O_Colombia 2017_VACS Cognitive Lab Report.pdf Supplementary Document Uploaded 2021-12-03 Repair queued
Attachment N_Malawi 2013 NCHS_VACS Cognitive Lab Report.pdf Supplementary Document Uploaded 2021-12-03 Repair queued
Attachment M_Philippines 2012 NCHS_VACS Cognitive Lab Report.pdf Supplementary Document Uploaded 2021-12-03 Missing upstream
Attachment L_Response Plan Distress Protocol_US VACS Adaptation.docx Supplementary Document Uploaded 2021-12-03 Repair queued
AttachmentG_IRB Approval.pdf Supplementary Document Uploaded 2020-12-15 Missing upstream
AttachmentC_Privacy Impact Assessment (PIA).pdf Supplementary Document Uploaded 2020-12-15 Repair queued
AttachmentB_ 60 Dy FRN VACS.pdf Supplementary Document Uploaded 2020-12-15 Repair queued
AttachmentA_ Authorizing Legislation.docx Supplementary Document Uploaded 2020-12-15 Repair queued
SSB__VACS_FINAL_v2.docx Supporting Statement B Uploaded 2021-12-02 Repair queued
SSA__VACS_FINAL_v2.docx Supporting Statement A Uploaded 2021-12-02 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
250663 Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire Form and Instruction Modified
250654 Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Consent/Assent Form and Instruction Unchanged
250653 Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Household Questionnaire Form and Instruction Unchanged
250651 Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Houehold Consent Form and Instruction Unchanged
250648 Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire Form and Instruction Modified
250647 Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter Form Unchanged
250646 Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol Form and Instruction Unchanged
250644 Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent Form and Instruction Unchanged
250643 Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent Form and Instruction Unchanged
250641 Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening Form and Instruction Unchanged
250640 Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry Form and Instruction Unchanged
250639 Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening Form and Instruction Unchanged
250638 Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry Form and Instruction Unchanged
ICR Details
0920-1356 202208-0920-008
Received in OIRA 202012-0920-010
HHS/CDC 0920-22HW
Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US
No material or nonsubstantive change to a currently approved collection   No
Regular 08/11/2022
  Requested Previously Approved
12/31/2024 12/31/2024
8,449 8,449
872 872
0 0
This request is to conduct the Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the United States, which CDC has conducted in 24 countries globally and has adapted for a domestic context. More specifically, this request details the adaptations to the survey and methods for piloting the survey in one urban and one rural area of the United States.
US Code: 42 USC 241 Name of Law: PHSA
  
None
Not associated with rulemaking
  85 FR 45432 07/28/2020
86 FR 1111 01/07/2021
No
13
IC Title Form No. Form Name
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Household Questionnaire NA Head of Household Questionnaire
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Invitation Letter NA Invitation Letter
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Head of Houehold Consent NA Head of Household Consent
Head of Household (Pre-test 2, rural feasibility pilot in Garrett County, full implementation pilot in Baltimore City) Screener Questionnaire 0920-22HW Screening Questionnaire
Pre-Test 1 (Parents of youth ages 13-17) Cognitive Interview Screening NA Cognitive interview screening
Pre-Test 1 (Parents of youth ages 13-17) Cognitive interview response to flyer/ telephone inquiry NA Cognitive interview response to flyer/ telephone inquiry
Pre-Test 1 (Parents of youth ages 13-17) Informed Parental Consent NA Informed parental consent
Pre-Test 1 (Youth ages 13-24) Cognitive Interview Protocol NA Cognitive Interview Protocol
Pre-Test 1 (Youth ages 13-24) Cognitive interviewing consent/assent NA Cognitive interviewing consent/assent
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview response to flyer/ telephone inquiry NA Cognitive interview response to flyer/ telephone inquiry
Pre-Test 1 - (Youth Ages 18-24) - Cognitive interview screening NA Cognitive interview screening
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Consent/Assent NA Youth Respondent Consent/Assent
Youth ages 13-24 in Baltimore City or Garrett County, Maryland (Pre-test 2, rural feasibility pilot, full implementation pilot) Youth Respondent Questionnaire 0920-22HW DVACS Youth Participant Questionnaire
  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 8,449 8,449 0 0 0 0
Annual Time Burden (Hours) 872 872 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
This is a new ICR.
$1,960,867
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Odion Clunis 770 488-0045 [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.
08/11/2022