View Information Collection Request (ICR) Package
Skip to main content
An official website of the United States government
The .gov means it's official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.
The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.
Search:
Agenda
Reg Review
ICR
This script is used to control the display of information in this page.
Display additional information by clicking on the following:
All
Brief and OIRA conclusion
Abstract/Justification
Legal Statutes
Rulemaking
FR Notices/Comments
IC List
Burden
Misc.
Common Form Info.
Certification
View Information Collection (IC) List
View Supporting Statement and Other Documents
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:
0970-0503
ICR Reference No:
201711-0970-002
Status:
Historical Active
Previous ICR Reference No:
201710-0970-007
Agency/Subagency:
HHS/ACF
Agency Tracking No:
Title:
Responding to Intimate Violence in Relationship Programs (RIViR)
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:
11/13/2017
Retrieve Notice of Action (NOA)
Date Received in OIRA:
11/13/2017
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
11/30/2020
11/30/2020
11/30/2020
Responses
3,600
0
3,600
Time Burden (Hours)
550
0
550
Cost Burden (Dollars)
0
0
0
Abstract:
The Administration for Children and Families (ACF) at the U.S. Department of Health and Human Services (HHS) seeks approval for data collection as a component of the Responding to Intimate Violence in Relationship Programs (RIVIR) project. The goals of this research project are to develop improved theoretical frameworks, screening tools, and surrounding protocols for recognizing and addressing intimate partner violence (IPV) and teen dating violence (TDV) in healthy marriage and relationship education (HMRE) programs with the diverse, middle- to low-income populations they serve. We are studying HMRE programs, and we are referring to them as “healthy relationship” (HR) programs in this project (and consequently throughout this document). This project has already conducted several activities using existing data sources and materials to synthesize information about the current state of the field and to identify potential IPV and TDV screeners and protocols. The project is now planning to test these IPV and TDV screeners and surrounding protocols in HR programs. This Information Collection Request seeks approval for this testing component of the RIVIR project. We plan to test standardized quantitative tools, as well as open-ended scripts that create opportunities for disclosure of IPV or TDV among adults and youth who participate in HR programs. This work will include data collection from approximately 1,200 HR program participants and will be completed in collaboration with approximately four HR grantee organizations funded by ACF’s Office of Family Assistance (OFA) to implement HR programs.
Authorizing Statute(s):
PL:
Pub.L. 74 - 271 403(a)(2)
Name of Law: Social Security Act as amended by the Welfare Integrity and Data Improvement Act of FY12
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:
81 FR 21553
04/12/2016
30-day Notice:
Federal Register Citation:
Citation Date:
81 FR 78835
11/09/2016
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
12
IC Title
Form No.
Form Name
1.1: IPV Screener 1
1.2: IPV Screener 2
1.3: IPV Screener 3
2.1: TDV Screener 1
2.2: TDV Screener 2
2.3: TDV Screener 3
Administration of data collection protocol and record-keeping
Contact information form for parents of youth younger than 18 (C.3)
Locator section for adults (C.2)
Participant recruitment
Post screener questions for adults (C.1)
Post screener questions for youth (C.1)
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
3,600
3,600
0
0
0
0
Annual Time Burden (Hours)
550
550
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.
Annual Cost to Federal Government:
$430,000
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.
Yes
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
Agency Contact:
Molly Buck 202 205-4724 mary.buck@acf.hhs.gov
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:
11/13/2017
An official website of the United States government
The .gov means it's official.
The site is secure.
