Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"

Forms and Documents

Document Name	Status
Form no National Organization Training and Technical Assistance Reporting Form Form	Modified
Form no State and Community Awardee Training and Technical Assistance Reporting Form Form	Modified
State and Community Awardee Staff Needs Assessment Form	Modified
State and Community Awardee Project Director/Project Coordinator Needs Assessment Form	Modified
State and Community Awardee Performance Measure Reporting Tool Form and Instruction	Modified
Community and Clinical Partner Program Implementation Partner Needs Assessment Form and Instruction	Modified
Community and Clinical Partner Clinical Partner Needs Assessment Form and Instruction	Modified
0920-0952 Change Request Justification 01APR13.docx Justification for No Material/Nonsubstantive Change	2013-04-02
Attachment 8 (rev) State and Community Awardee Staff Needs Assessment.docx Supplementary Document	2013-04-02
Attachment 7 (rev) State and Community Awardee Project Coordinator Project Director Needs Assessment.docx Supplementary Document	2013-04-02
Att 11. Description of Assessment Tools.docx Supplementary Document	2012-09-04
Att 12. Clinical Component Best Practices.docx Supplementary Document	2012-09-04

IC Document Collections

IC ID	Document Title	Status
203977	National Organization Training and Technical Assistance Reporting Form Form	Modified
203976	State and Community Awardee Training and Technical Assistance Reporting Form Form	Modified
203975	State and Community Awardee Staff Needs Assessment Form	Modified
203974	State and Community Awardee Project Director/Project Coordinator Needs Assessment Form	Modified
203973	State and Community Awardee Performance Measure Reporting Tool Form and Instruction	Modified
203972	Community and Clinical Partner Program Implementation Partner Needs Assessment Form and Instruction	Modified
203971	Community and Clinical Partner Clinical Partner Needs Assessment Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0952	ICR Reference No: 201304-0920-002
Status: Historical Active	Previous ICR Reference No: 201209-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 19224
Title: Process Evaluation of "Teenage Pregnancy Prevention: Integrating Services, Programs, and Strategies through Community-Wide Initiatives"
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: 04/03/2013
	Date Received in OIRA: 04/02/2013
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2015	12/31/2015	12/31/2015
Responses	1,039	0	1,039
Time Burden (Hours)	1,150	0	1,150
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC is seeking approval for web-based collection of this process evaluation. CDC plans to collect the information needed to conduct a process and intermediate outcome evaluation of community-wide teen pregnancy prevention efforts involving nine state and community awardees, and five national organizations.

---

Authorizing Statute(s): PL: Pub.L. 111 - 117 D Name of Law: Consolidated Appropriations Act of 2012
   US Code: 42 USC 301 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

Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 7

IC Title	Form No.	Form Name
Community and Clinical Partner Clinical Partner Needs Assessment	N/A	Att 4 Clincal Partner Needs Assessment.Revised
Community and Clinical Partner Program Implementation Partner Needs Assessment	N/A	Att 5 Com and Clinical Partners Prog Implem Partner Needs Assmt.Revised
State and Community Awardee Performance Measure Reporting Tool	N/A	Att 6 State and Community Awardee Performance Measure Reporting Tool.Revised
State and Community Awardee Project Director/Project Coordinator Needs Assessment	none	New Web Survey
State and Community Awardee Staff Needs Assessment	none	new Web-based Survey
State and Community Awardee Training and Technical Assistance Reporting Form	no	State and Community Awardee Training and Technical Assistance Reporting Form
National Organization Training and Technical Assistance Reporting Form	no	National Organization Training and Technical Assistance Reporting Form

---

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	1,039	1,039	0	0	0	0
Annual Time Burden (Hours)	1,150	1,150	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:

---

Annual Cost to Federal Government: $462,427

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? Yes

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

---

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: 04/02/2013

---