Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs

ICR 201504-0920-004

OMB: 0920-1084

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
New
Form and Instruction
New
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supplementary Document
2015-04-10
Supporting Statement B
2015-09-08
Supporting Statement A
2015-09-08
IC Document Collections
ICR Details
0920-1084 201504-0920-004
Historical Active
HHS/CDC 15KX
Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 09/11/2015
Retrieve Notice of Action (NOA) 04/28/2015
  Inventory as of this Action Requested Previously Approved
09/30/2018 36 Months From Approved
60 0 0
60 0 0
0 0 0

The CDC requests a 3-year OMB approval to conduct a new information collection (IC) entitled, "Assessing Community-Based Organizations' Partnerships with Schools for the Prevention of HIV/STDs." The IC uses two versions of a self-administered web-based questionnaire --the Community-based organization (CBO) Assessment Questionnaire and the Health and/or Wellness Center (HWC) Assessment Questionnaire --to conduct an in-depth assessment with staff from CBOs and HWCs, which include school wellness centers and school-based health centers. The assessment will ask about partnerships and HIV and STD prevention efforts that are taking place in conjunction with the three local education agencies (LEAs) funded by the CDC, Division of Adolescent and School Health (DASH) under strategy 4 (School-Centered HIV/STD Prevention for Young MSM) of PS13-1308: Promoting Adolescent Health through School-Based HIV/STD Prevention and School-Based Surveillance.

US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  80 FR 3238 01/22/2015
80 FR 22192 04/21/2015
Yes

2
IC Title Form No. Form Name
Web-based CBO Assessment None District Partner Assessment - CBO
Web-basedHWC Assessment None District Partner Assessment - HWC

  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 60 0 0 60 0 0
Annual Time Burden (Hours) 60 0 0 60 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
0920-15KX is a New ICR

$45,739
Yes Part B of Supporting Statement
No
No
No
No
Uncollected
Jeffrey Zirger 404 639-7118 wtj5@cdc.gov

  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.
04/28/2015


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