Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations

Forms and Documents

Document Name	Status
Form 12 Child Followup- Screenshot Form	Unchanged
Form 11 Child Posttest -Screenshot Form	Unchanged
Form 10 Child Pretest - Screenshot Form	Unchanged
Form 6 Adults Programs Usage Log Form	Unchanged
Form 5 Adult Follow-up - Screenshot Form	Unchanged
Form 4 Adult Post-test - Screenshot Form	Unchanged
Form 3 Adult Pretest - Screenshot Form	Unchanged
Form 2 Child Assent Form Form and Instruction	Unchanged
Form 1 Permission and Consent Form Form and Instruction	Unchanged
Change Request memo OMB 0925-0685 (1).doc Justification for No Material/Nonsubstantive Change	2015-02-10
SSB - Revised OMB 0925-0685 2-9-15.doc Supporting Statement B	2015-02-09
Attachment 13 Recruitment Materials.zip Supplementary Document	2013-11-05
Response to OMB Comments.docx Supplementary Document	2013-10-28
Attachment 17 Certification of Instructional Review Board.pdf Supplementary Document	2013-10-28
Attachment_11_-_Data_collection_instrument_-_Child_questionnaire_Followup_MDF[1].pdf Supplementary Document	2013-11-06
Attachment 9 - Data collection instrument - Child questionnaire Posttest MDF.pdf Supplementary Document	2013-11-06
Attachment_7_-_Data_collection_instrument_-_Child_questionnaire_Pretest_MDF[1].pdf Supplementary Document	2013-11-06
Attachment_5_-_Data_collection_instrument_-_Adult_questionnaire_Followup_MDF[1].pdf Supplementary Document	2013-11-06
Attachment_3_-_Data_collection_instrument_-_Adult_questionnaire_Posttest_MDF[1].pdf Supplementary Document	2013-11-06
Attachment_1_-_Data_collection_instrument_-_Adult_questionnaire_-_Pretest_MDF[1].pdf Supplementary Document	2013-11-06
SSA - Revised OMB 0925-0685 2-9-15.doc Supporting Statement A	2015-02-09

IC Document Collections

IC ID	Document Title	Status
209246	Child Followup- Screenshot Form	Unchanged
209245	Child Posttest -Screenshot Form	Unchanged
209244	Child Pretest - Screenshot Form	Unchanged
209243	Adults Programs Usage Log Form	Unchanged
209242	Adult Follow-up - Screenshot Form	Unchanged
209241	Adult Post-test - Screenshot Form	Unchanged
209240	Adult Pretest - Screenshot Form	Unchanged
209239	Child Assent Form Form and Instruction	Unchanged
209238	Permission and Consent Form Form and Instruction	Unchanged

ICR Details

OMB Control No: 0925-0685	ICR Reference No: 201502-0925-002
Status: Historical Active	Previous ICR Reference No: 201311-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No: 20779
Title: Web-based Media Literacy Parent Training for Substance Use Prevention in Rural Locations
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/12/2015
	Date Received in OIRA: 02/10/2015
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2015	11/30/2015	11/30/2015
Responses	2,000	0	2,000
Time Burden (Hours)	1,067	0	1,067
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of this project is to evaluate a media literacy substance use prevention intervention, Media Detective Family, for parents and their school-aged children using a randomized controlled trial and establish MDF as an evidence-based intervention. MDF reduces barriers to prevention efforts in rural areas by delivering the intervention on an interactive website or a mobile or wireless devise. MDF focuses on improving children's alcohol and tobacco use knowledge and intentions, and adults' and children's media literacy knowledge and skills. A total of approximately 200 parent-child pairs will be recruited from 6 rural counties in North Carolina and Texas, with 100 pairs randomly assigned to each condition (intervention/control). Information will be collected on knowledge, norms, skills, behavior, behavioral intentions, and demographic characteristics of participating children and adults. Data collection using audio computer-assisted self interviewing will occur at three time points: at pretest, after using MDF or a control computer program for one month, and at 3-month follow-up. Benefits will include improvements in critical thinking skills and parent-child communication about substances and the media, and an increase in rural families receiving evidence-based prevention programming.

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Authorizing Statute(s): None

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 18612	03/27/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 35040	06/11/2013
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 9

IC Title	Form No.	Form Name
Permission and Consent Form	1	Consent Form
Child Assent Form	2	Child Assent
Adult Pretest - Screenshot	3	Adult Pretest -Screenshot
Adult Post-test - Screenshot	4	Adult Post-test -Screenshot
Adult Follow-up - Screenshot	5	Adult Follow-up
Adults Programs Usage Log	6	Adults Usage Log
Child Pretest - Screenshot	10	Child Pretest
Child Posttest -Screenshot	11	Child Posttest
Child Followup- Screenshot	12	Child Followup

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ICR Summary of Burden

	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	2,000	2,000	0	0	0	0
Annual Time Burden (Hours)	1,067	1,067	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new information collection.

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Annual Cost to Federal Government: $507,808

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 02/10/2015

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