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Agenda
Reg Review
ICR
View Information Collection (IC)
View Information Collection (IC)
IC Title:
DASH DEMO: Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Professional Development (PD) Pilot Study
Agency IC Tracking Number:
0920-0840-22FM
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form
0920-0840
#1 Webinar- Adolescent Growth and Development
Att 2_Adolescent Growth and Development survey.pdf
Yes
Yes
Fillable Fileable
Form
0920-0840
#2 Webinar- Assess and Adjust:
Att 3_Assess and Adjust survey.pdf
Yes
Yes
Fillable Fileable
Form
0920-0840
#3 E-learning module survey- Basic Principles of Teaching Health Education
Att 4_Basic Principles of Teaching HE_elearning survey.pdf
Yes
Yes
Fillable Fileable
Form
0920-0840
#2 E-learning module survey- Culturally Responsive Health Education Classroom
Att 5_Culturally Responsive survey.pdf
Yes
Yes
Fillable Fileable
Form
0920-0840
In-person training evaluation
Att 6_In-person training survey.pdf
Yes
Yes
Fillable Fileable
Form
0920-0840
Micro Session Survey
Att 7_Micro session survey.pdf
Yes
Yes
Fillable Fileable
Form
0920-0840
#1 E-learning module survey- Trauma informed approach
Att 8_TIA elearning module survey.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0840
Teacher Survey
Att 9_Teacher Survey.pdf
Yes
Yes
Fillable Fileable
Form and Instruction
0920-0840
Student Survey
Att 10_Student Survey.pdf
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Illness Prevention
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
975
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
100 %
Approved
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
975
0
975
0
0
0
Annual IC Time Burden (Hours)
287
0
287
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Authorizing Legislation
Att 1_Auth Legislation.docx
05/13/2022
#1 Webinar- Adolescent Growth and Development (screenshot)
Att 2a_Adolescent Growth and Development_screenshot.pdf
05/13/2022
#2 Webinar- Assess and Adjust (screenshots)
Att 3a_Assess and Adjust_screenshot.pdf
05/13/2022
#3 E-learning module survey- Basic Principles of Teaching Health Education (screenshots)
Att 4a_ Basic Principles of Teaching Health Education_screenshots.pdf
05/13/2022
#2 E-learning module survey- Culturally Responsive Health Education Classroom
Att 5a_Culturally Responsive Health Education Classroom_screenshot.pdf
05/13/2022
In-person training evaluation (screenshots)
Att 6a_In-Person Training Evaluation_screenshot.pdf
05/13/2022
Micro Session Survey
Att 7a_CHECKS_Micro Session Survey_screenshot.pdf
05/13/2022
E-Learning Trauma Informed Approach (screenshots)
Att 8a_E-Learning Trauma Informed Approach_screenshot.pdf
05/13/2022
Teacher Survey (screenshots)
Att 9a_Teacher tool_screenshots.pdf
05/13/2022
Student Survey (screenshots
Att 10a_Student Tool_screenshots.pdf
05/13/2022
Invitation Letter for Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Study
Att 11_CHECKS PD_Invitation Email.pdf
05/13/2022
Reminder- Invitation Letter for Comprehensive Health Educator Core Knowledge and Skills (CHECKS) Study
Att 11a_CHECKS PD_Pilot_Reminder Email.pdf
05/13/2022
CHECKS TRAINING STUDY- TEACHER CONSENT
Att 12_CHECKS PD Pilot_Teacher Consent.pdf
05/13/2022
CHECKS STUDY- STUDENT ASSENT FORM
Att 13_CHECKS PD Student Assent.pdf
05/13/2022
CHECKS STUDY- STUDENT ASSENT FORM
Att 14_CHECKS PD_Parental Consent Form.pdf
05/13/2022
ICF IRB Approval
Att 15_ICF IRB Approval.pdf
05/13/2022
Notification of IRB Determination for CHECKS PD Pilot Study (email)
Att 15a_Notification of IRB Determination for CHECKS PD Pilot Study.pdf
05/13/2022
Respondent Universe
Att 16_Respondent Universe.docx
05/13/2022
CHECK PD Pilot_Consultants
Att 17_CHECKS PD Pilot_Consultants.docx
05/13/2022
PIA
Att 18_CHECKS_PIA.pdf
05/13/2022
60dy published FRN
Att 19_60 Day FRN Published 2-12-2021.pdf
05/13/2022
NCHHSTP Project Determination
Att 21_NCHHSTP Project Determination_CHECKS PD Pilot Study.docx
05/13/2022
Supporting Statement A
SSA-CHECKs PD Pilot Study_03.21.22.docx
05/13/2022
Supporting Statement B
SSB-CHECKs PD Pilot Study_03.21.22.docx
05/13/2022
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.