Responding to Intimate Violence in Relationship Programs (RIViR)

Forms and Documents

Document Name	Status
NonSub Change Memo - RIViR - Updates for IRB language.docx Justification for No Material/Nonsubstantive Change	2017-11-13
RIViR_OMB_SSB_Oct 12 2017_clean.doc Supporting Statement B	2017-10-16
RIVIR SSA_11 3 17_clean final.docx Supporting Statement A	2017-11-03
RIViR OMB Resubmission Memo_Oct 12 2017.docx Supplementary Document	2017-10-16
Att_B.4s_Parent permission script_11-9-17_Spanish_CLEAN.docx Supplementary Document	2017-11-13
Att_B.3s_Parent permission form_11-9-17_Spanish_CLEAN.docx Supplementary Document	2017-11-13
References_Oct 13 2017.docx Supplementary Document	2017-10-16
Att_F.1_IRB Approval Notice_renewed.pdf Supplementary Document	2017-10-16
Att_D.1_Existing IPV & TDV measures_7-18-17_clean.docx Supplementary Document	2017-10-16
Att_B.8_Youth over 18_consent script_9-26-17_clean.docx Supplementary Document	2017-10-16
Att_B.7_Youth over 18_consent form_11-9-17_CLEAN.docx Supplementary Document	2017-11-13
Att_B.6_Youth assent script_9-26-17_clean.docx Supplementary Document	2017-10-16
Att_B.5_Youth assent form_11-9-17_CLEAN.docx Supplementary Document	2017-11-13
Att_B.4_Parent permission script_11-9-17_CLEAN.docx Supplementary Document	2017-11-13
Att_B.3_Parent Permission Form_11-9-17_CLEAN.docx Supplementary Document	2017-11-13
Att_B.2_Adult consent script_9-26-17_clean.docx Supplementary Document	2017-10-16
Att_B.1_Adult consent form_9-26-17_clean.docx Supplementary Document	2017-11-13
Att_A.3_Recruitment script for youth 18+_9-7-17_clean.docx Supplementary Document	2017-10-16
Att_A.2_Recruitment script for adults_6-9-17_clean.docx Supplementary Document	2017-10-16
Att_A.1_Lead letter for parents_9-7-17_clean.docx Supplementary Document	2017-10-16

IC Document Collections

IC ID	Document Title	Status
224373	Administration of data collection protocol and record-keeping Other-Staff involvement in data collection	Unchanged
224372	Participant recruitment Other-Recruitment Efforts	Unchanged
224371	Contact information form for parents of youth younger than 18 (C.3) Other-Contact Form	Unchanged
224370	Locator section for adults (C.2) Other-Locator Section	Unchanged
224369	Post screener questions for youth (C.1) Other-Post Screener	Unchanged
224368	Post screener questions for adults (C.1) Other-Post Screener	Unchanged
224367	2.3: TDV Screener 3 Other-Screener	Unchanged
224366	2.2: TDV Screener 2 Other-Screener	Unchanged
224365	2.1: TDV Screener 1 Other-Screener	Unchanged
224364	1.3: IPV Screener 3 Other-Screener	Unchanged
224363	1.2: IPV Screener 2 Other-Screener	Unchanged
224362	1.1: IPV Screener 1 Other-Screener	Unchanged

ICR Details

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
	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

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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.

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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

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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:
	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

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Number of Information Collection (IC) in this ICR: 12

IC Title	Form No.	Form Name
Administration of data collection protocol and record-keeping
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
Post screener questions for adults (C.1)
Post screener questions for youth (C.1)
Locator section for adults (C.2)
Contact information form for parents of youth younger than 18 (C.3)
Participant recruitment

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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.

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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

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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: 11/13/2017

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