View Information Collection Request (ICR) Package
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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:
0990-0472
ICR Reference No:
202001-0990-001
Status:
Historical Active
Previous ICR Reference No:
Agency/Subagency:
HHS/HHSDM
Agency Tracking No:
Title:
Evaluation of Pregnancy Prevention Program Replications for High Risk and Hard to Reach Youth
Type of Information Collection:
New collection (Request for a new OMB Control Number)
Common Form ICR:
No
Type of Review Request:
Regular
OIRA Conclusion Action:
Approved with change
Conclusion Date:
04/17/2020
Retrieve Notice of Action (NOA)
Date Received in OIRA:
03/04/2020
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
04/30/2023
36 Months From Approved
Responses
11,610
0
0
Time Burden (Hours)
4,859
0
0
Cost Burden (Dollars)
0
0
0
Abstract:
The Office of the Assistant Secretary for Health (OASH), U.S. Department of Health and Human Services (HHS), is requesting approval by OMB of a new information collection request specific to Pregnancy Prevention Programs for Adolescents: A Replication Study. The request is for 24 months. OASH is proposing to conduct an independent evaluation examining whether programs that have been proven effective through rigorous evaluation can be replicated with similarly successful and consistent results among hard-to-reach, high-risk, vulnerable, or understudied youth. The independent evaluator, MITRE, will use a quasi-experimental design to measure program effects on youth knowledge, attitudes, beliefs, intentions, and behaviors related to sexual health. The evaluation will also examine youth perspectives regarding participation in adolescent pregnancy prevention programs. Up to eight implementing organizations—organizations focused on health, education, and social services that have experience working with community-based organizations to implement pregnancy prevention programs for adolescents—will implement previously proven-effective adolescent pregnancy prevention programs for up to 1,900 youth. Baseline data will be collected from a matched comparison group with a subset of these participating program youth. Findings will inform OASH’s programmatic efforts to improve sexual health knowledge, attitudes, beliefs, intentions, and behaviors among hard-to-reach, vulnerable, or understudied youth.
Authorizing Statute(s):
US Code:
42 USC 241
Name of Law: Public Health Service Act
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:
84 FR 216
11/07/2019
30-day Notice:
Federal Register Citation:
Citation Date:
85 FR 5217
01/29/2020
Did the Agency receive public comments on this ICR?
No
Number of Information Collection (IC) in this ICR:
6
IC Title
Form No.
Form Name
3 month follow-up survey
5
3 month follow-up youth survey
Focus Group Assent Form
7
Focus Group assent
Focus group participation/protocol
6
focus group participation/protocol
Follow-up Survey
4
youth follow-up survey
Parental Consent Form
1
Parental consent for youth participation in study
Youth Baseline Form and Assent
2, 3
Youth Assent Form for Youth Survey
,
Youth baseline survey
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
11,610
0
0
11,610
0
0
Annual Time Burden (Hours)
4,859
0
0
4,859
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:
No
Burden Reduction Due to:
Short Statement:
new collection
Annual Cost to Federal Government:
$5,330,000
Does this IC contain surveys, censuses, or employ statistical methods?
No
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
Agency Contact:
Alicia Richmond Scott 240 453-2816 alicia.richmond@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:
03/04/2020
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