View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0761
ICR Reference No:
201003-0920-008
Status:
Historical Active
Previous ICR Reference No:
200812-0920-002
Agency/Subagency:
HHS/CDC
Agency Tracking No:
Title:
Randomized Controlled Trial for Routine Screening for Intimate Partner Violence
Type of Information Collection:
Revision of a currently approved collection
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
04/26/2010
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/17/2010
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2013
36 Months From Approved
01/31/2011
Responses
1,753
0
3,814
Time Burden (Hours)
308
0
718
Cost Burden (Dollars)
0
0
0
Abstract:
Intimate partner violence (IPV) occurs frequently and has serious health, economic, and social consequences. Given the seriousness of this problem, numerous professional and health care organizations have recommended routine screening of women for IPV by health care providers in primary care settings. The Centers for Disease Control and Prevention (CDC) is requesting approval of revisions resulting from findings after conducting the Pretest.
Authorizing Statute(s):
US Code:
42 USC 391
Name of Law: Public Health Service Act Prevention and Control of Injuries
US Code:
42 USC 301
Name of Law: Public Health Service Act Research and Investigation General
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
74 FR 66976
12/17/2009
30-day Notice:
Federal Register Citation:
Citation Date:
75 FR 8955
02/26/2010
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
Baseline Questionnaire
no number
Baseline
Baseline Questionnaire Main Study
no number
Baseline
Eligibility Script for Main Study
no number
Eligibility Script
Eligibility Script for Pretest
no number
Eligibility Script
Follow-up Questionnaire Main Study
no number
Follow-up
Pretest Followup
no number
Follow-up
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
1,753
3,814
0
-2,061
0
0
Annual Time Burden (Hours)
308
718
0
-410
0
0
Annual Cost Burden (Dollars)
0
0
0
0
0
0
Burden increases because of Program Change due to Agency Discretion:
Yes
Burden Increase Due to:
Miscellaneous Actions
Burden decreases because of Program Change due to Agency Discretion:
Yes
Burden Reduction Due to:
Miscellaneous Actions
Short Statement:
The proposed changes are based on findings from the Pretest that showed high number of Spanish speakers at recruitment clinics, a higher prevalence of reported exposure to intimate partner violence, and redundancy of the 20-item mental health scale with other measures being used. This revision results in a reduction of burden hours.
Annual Cost to Federal Government:
$475,556
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?
No
Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]?
Uncollected
Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]?
Uncollected
Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)?
No
Is this ICR related to the Pandemic Response?
Uncollected
Agency Contact:
Maryam Daneshvar 4046394604
Common Form ICR:
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:
(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:
03/17/2010
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