Promoting Adolescent Health through School-based HIV/STD Prevention

Forms and Documents

Document Name	Status
NGO Exemplary Sexual Health Education Measures Form	Modified
NGO Safe and Supportive Environment Measures Form	Modified
NGO Sexual Health Services Measures Form	Modified
Local Education Agency Exemplary Sexual Health Education Measures Form	Modified
Local Education Agency Sexual Health Services Measures Form	Modified
Local Education Agency Safe and Supportive Environment Measures Form	Modified
State Education Agency Exemplary Sexual Health Education Measures Form	Modified
State Education Agency Sexual Health Services Measures Form	Modified
State Education Agency Safe and Supportive Environment Measures Form	Modified
Att 11 Eval Framework.pdf Supplementary Document	2017-10-17
Att 10 Analysis of Alternatives.doc Supplementary Document	2017-10-17
Att 7 Funded Agencies Providing Feedback.docx Supplementary Document	2017-10-17
Att 6 List of Funded Agencies.docx Supplementary Document	2017-10-17
Supporting Statement A 17OCT2017.docx Supporting Statement A	2017-10-17
Att 2 60 FRN.pdf Supplementary Document	2017-10-17
Att 1 Public Health Service Act Legislation.pdf Supplementary Document	2017-10-17
Att 9c SSE Rationale.pdf Supplementary Document	2014-09-04
Att 9b SHS Rationale.pdf Supplementary Document	2014-09-04
Att 9a ESHE Rationale.pdf Supplementary Document	2014-09-04
Supporting Statement B 17OCT2017.docx Supporting Statement B	2017-10-17

IC Document Collections

IC ID	Document Title	Status
212973	NGO Exemplary Sexual Health Education Measures Form	Modified
212972	NGO Safe and Supportive Environment Measures Form	Modified
212971	NGO Sexual Health Services Measures Form	Modified
212970	Local Education Agency Exemplary Sexual Health Education Measures Form	Modified
212969	Local Education Agency Sexual Health Services Measures Form	Modified
212968	Local Education Agency Safe and Supportive Environment Measures Form	Modified
212967	State Education Agency Exemplary Sexual Health Education Measures Form	Modified
212966	State Education Agency Sexual Health Services Measures Form	Modified
212965	State Education Agency Safe and Supportive Environment Measures Form	Modified

ICR Details

OMB Control No: 0920-1049	ICR Reference No: 201710-0920-008
Status: Historical Active	Previous ICR Reference No: 201409-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1049
Title: Promoting Adolescent Health through School-based HIV/STD Prevention
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/16/2018
	Date Received in OIRA: 10/24/2017
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2019	12 Months From Approved	02/28/2018
Responses	222	0	228
Time Burden (Hours)	804	0	820
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this request is to obtain a one-year extension for data collection using a Web-based program evaluation and monitoring system that will use Web-based questionnaires to organize, plan, and track PS13-1308 funded agency activities conducted to meet the performance and process measures established by the Centers for Disease Control and Prevention (CDC), National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Division of Adolescent and School Health, (DASH). The system will provide access to data and reports for DASH and its funded agencies (state and local education agencies and non-governmental organizations), which allows areas for improvement to be identified and addressed efficiently. These questionnaires will include performance and process measures to be used for program monitoring, evaluation, and quality improvement for HIV/STD prevention activities.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

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:
	82 FR 16833	04/06/2017
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 48814	10/20/2017
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
State Education Agency Safe and Supportive Environment Measures	NA, NA	SEA SSE Measures ,   SEA - Screenshots
State Education Agency Sexual Health Services Measures	NA	SEA SHS Measures
Local Education Agency Exemplary Sexual Health Education Measures	NA	LEA ESHE Measures
Local Education Agency Sexual Health Services Measures	NA	LEA SHS Measures
NGO Sexual Health Services Measures	NA, NA	NGO SHS Measures ,   NGO - Screenshots
NGO Safe and Supportive Environment Measures	NA	NGO SSE Measures
State Education Agency Exemplary Sexual Health Education Measures	NA	SEA ESHE Measures
Local Education Agency Safe and Supportive Environment Measures	NA, NA	LEA SSE Measures ,   LEA - Screenshots
NGO Exemplary Sexual Health Education Measures	NA	NGO ESHE Measures

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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	222	228	0	-6	0	0
Annual Time Burden (Hours)	804	820	0	-16	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Submission of 0920-1049 is an Extension ICR. Decrease in Burden Hours is due to State Education Agencies dropping out of the previously approved information collection process.

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Annual Cost to Federal Government: $498,851

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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

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: 10/24/2017

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