Evaluation of the Second Decade Project Community Planning Guide

Forms and Documents

Document Name	Status
Attachment I - Secondary Stakeholder Survey - Web Screenshots.pdf Supplementary Document	2016-08-29
Evaluation of the Second Decade Project Community Planning Guide_IRB Approval_June 24 2016 - for OMB.pdf Supplementary Document	2016-08-29
Attachment E - List of Interview Topics for the Coalition Member Focus Group (CFG).docx Supplementary Document	2016-08-29
Attachment C - List of Interview Topics for the Community Leader Interview (CLI).docx Supplementary Document	2016-08-29
Attachment A - Introductory Letters.docx Supplementary Document	2016-08-29
Attachment G - Coalition Assessment Survey - Web Screenshots.pdf Supplementary Document	2016-08-29
Supporting Statement Part B--OASH_FINAL Revised 011917.docx Supporting Statement B	2017-01-19
Supporting Statement Part A -- OASH_Final REVISED 011917.docx Supporting Statement A	2017-01-19

IC Document Collections

IC ID	Document Title	Status
221947	Secondary Stakeholder Survey Other-survey	New
221946	Coalition Assessment Survey Other-survey	New
221944	Coalition Member Focus Group Other-focus group	New
221943	Community Leader Interview Other-survey	New

ICR Details

OMB Control No: 0990-0453	ICR Reference No: 201606-0990-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Evaluation of the Second Decade Project Community Planning Guide
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: 01/19/2017
	Date Received in OIRA: 08/29/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2020	36 Months From Approved
Responses	430	0	0
Time Burden (Hours)	218	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The evaluation of the Second Decade Project Community Planning Guide (“the evaluation”) is intended to support the goals of OASH’s Second Decade Project of helping community leaders incorporate the needs of children, adolescents and young adults in community growth and development plans, and to improve outcomes of young adults and adolescents.

---

Authorizing Statute(s): US Code: 42 USC 1707 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:
	81 FR 26237	05/02/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 57594	08/23/2016
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

IC Title	Form No.	Form Name
Secondary Stakeholder Survey
Community Leader Interview
Coalition Member Focus Group
Coalition Assessment 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	430	0	0	430	0	0
Annual Time Burden (Hours)	218	0	0	218	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: $271,176

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]? 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: 08/29/2016

---