Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US

Forms and Documents

Document Name	Status
Youth participant questionnaire Form	New
Youth participant consent Form and Instruction	New
Head of household questionnaire Form	New
Head of household Consent Form and Instruction	New
Screener Form and Instruction	New
Invitation to participate Form and Instruction	New
AttachmentG_IRB Approval.pdf Supplementary Document	2020-12-15
AttachmentC_Privacy Impact Assessment (PIA).pdf Supplementary Document	2020-12-15
AttachmentB_ 60 Dy FRN VACS.pdf Supplementary Document	2020-12-15
AttachmentA_ Authorizing Legislation.docx Supplementary Document	2020-12-15
SSB__VACS_12.14.2020.docx Supporting Statement B	2020-12-15
SSA _ VACS_12.14.2020.docx Supporting Statement A	2020-12-15

IC Document Collections

IC ID	Document Title	Status
244953	Youth participant questionnaire Form	New
244952	Youth participant consent Form and Instruction	New
244951	Head of household questionnaire Form	New
244949	Head of household Consent Form and Instruction	New
244941	Screener Form and Instruction	New
244940	Invitation to participate Form and Instruction	New

ICR Details

OMB Control No:	ICR Reference No: 202012-0920-010
Status: Received in OIRA	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-20QO
Title: Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the US
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 01/11/2021

	Requested	Previously Approved
Expiration Date	36 Months From Approved
Responses	8,272	0
Time Burden (Hours)	834	0
Cost Burden (Dollars)	23,761	0

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Abstract: This request is to conduct the Pilot Implementation of the Violence Against Children and Youth Survey (VACS) in the United States, which CDC has conducted in 24 countries globally and has adapted for a domestic context. More specifically, this request details the adaptations to the survey and methods for piloting the survey in one urban and one rural area of the United States.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 45432	07/28/2020
30-day Notice:	Federal Register Citation:	Citation Date:
	86 FR 1111	01/07/2021
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

IC Title	Form No.	Form Name
Head of household Consent	none	Head of household consent
Head of household questionnaire	none	Head of household questionnaire
Youth participant consent	none	Participant consent
Youth participant questionnaire	none	Youth participant questionnaire
Invitation to participate	none	Invitation to participate
Screener	none	Screener

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ICR Summary of Burden

	Total Request	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	8,272	0	0	8,272	0	0
Annual Time Burden (Hours)	834	0	0	834	0	0
Annual Cost Burden (Dollars)	23,761	0	0	23,761	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: This is a new ICR.

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Annual Cost to Federal Government: $1,960,867

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.     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? No

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Common Form ICR:  No

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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: 01/11/2021

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