[NCCDPHP] Healthy Schools Program Evaluation

Forms and Documents

Document Name	Status
Form 0920-24BJ Healthy Students Questionnaire Form	Modified
Form 0920-24BJ Healthy Schools Questionnaire Form	Unchanged
Form 0920-24BJ LEA Interviews Form	Modified
Form 0920-24BJ Recipient Interviews Form	Modified
Form 0920-24BJ Monthly Reporting Form	Modified
Change Request Memo - DASH DP-23-0002 (Clean) 2025.05.02 V4.1.docx Justification for No Material/Nonsubstantive Change	2025-05-13
Attachment 12 - Screenshots of Healthy Student Questionnaire_updated w Race Ethnicity Q 10.31.24 (1) (002).docx Supplementary Document	2025-01-04
Attachment 11 - Healthy Student Questionnaire updated w Race Ethnicity Q 10.31.24.docx Supplementary Document	2025-01-04
FRN 30 Day Text - 2302 Healthy Schools Evaluation (003).docx Supplementary Document	2024-08-22
Attachment 20 - 2302 Healthy Schools IRB determination letter 06-05-24.pdf Supplementary Document	2024-08-22
Attachment 19 - Healthy Student Questionnaire Student Assent Form (final) 6.14.24.docx Supplementary Document	2024-08-22
Attachment 18 - Healthy Student Questionnaire 18+ Consent Form (final) 6.14.24.docx Supplementary Document	2024-08-22
Attachment 16 - Healthy Schools Questionnaire Consent Form (final) 6.14.24.docx Supplementary Document	2024-08-22
Attachment 17 - Healthy Students Questionnaire Parent Consent Forms.docx Supplementary Document	2024-08-22
Attachment 15 - Interview Consent Forms.docx Supplementary Document	2024-08-22
Attachment 13 - Published 60 day FRN Healthy Schools.pdf Supplementary Document	2024-08-22
Attachment 10 - Screenshots of Healthy Schools Questionnaire (final) 6.14.24.docx Supplementary Document	2024-08-22
Attachment 12 - Screenshots of Healthy Student Questionnaire (final) 6.14.24.docx Supplementary Document	2024-08-22
Attachment 08 - Interview Invitation Email.docx Supplementary Document	2024-08-22
Attachment 05 - Monthly Indicator Report Qualtrics Screenshots (EO revised) 2025.05.02.docx Supplementary Document	2025-05-13
Attachment 04 - Monthly Reporting Form Email Notification.docx Supplementary Document	2024-08-22
Attachment 02 - Authorizing Legislation - Evidence-Based Policymaking Act 2018.pdf Supplementary Document	2024-08-22
Attachment 01 - Authorizing Legislation - Public Health Service Act.pdf Supplementary Document	2024-08-22
Healthy Schools - SSB.docx Supporting Statement B	2024-08-22
Healthy Schools - SSA (EO revised, clean) 2025.04.21.docx Supporting Statement A	2025-05-13

IC Document Collections

IC ID	Document Title	Status
270338	Healthy Students Questionnaire Form	Modified
270336	Healthy Schools Questionnaire Form	Unchanged
270335	LEA Interviews Form	Modified
270334	Recipient Interviews Form	Modified
270318	Monthly Reporting Form	Modified

ICR Details

OMB Control No: 0920-1455	ICR Reference No: 202504-0920-011
Status: Received in OIRA	Previous ICR Reference No: 202408-0920-014
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-25-0077
Title: [NCCDPHP] Healthy Schools Program Evaluation
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 05/15/2025

	Requested	Previously Approved
Expiration Date	01/31/2028	01/31/2028
Responses	13,720	13,720
Time Burden (Hours)	6,900	6,900
Cost Burden (Dollars)	0	0

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Abstract: The proposed project aims to evaluate processes and outcomes of the programs of 20 state entities funded by CDC's Division of Adolescent and School Health to improve health, academic achievement, and well-being of students in K-12 schools nationwide. CDC awarded funds through cooperative agreement DP23-0002 (2302 Program) to 20 funding recipients (states, universities, and a tribal nation) to improve health, academic achievement, and well-being of students in K-12 schools. A portion of the funding within each state is allocated to one priority local education agency (LEA) and its corresponding schools to support the implementation of policies, practices, and programs to increase physical activity, healthy dietary behaviors, and management of chronic health conditions among students. CDC is conducting a mixed-methods multi-level evaluation of the 2302 Program and associated outcomes. Evaluation findings will allow CDC to help recipients improve their programs as they progress over the five-year funding period. This change request is to follow recent executive orders.

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Authorizing Statute(s): None

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:
	88 FR 85888	12/11/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 65351	08/09/2024
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

IC Title	Form No.	Form Name
Healthy Schools Questionnaire	0920-24BJ	Healthy Schools Questionnaire
Healthy Students Questionnaire	0920-24BJ	Healthy Student Questionnaire
LEA Interviews	0920-24BJ	Interview Guide Priority LEA
Monthly Reporting	0920-24BJ	Monthly Reporting Form
Recipient Interviews	0920-24BJ	Interview Guide Recipient

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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	13,720	13,720	0	0	0	0
Annual Time Burden (Hours)	6,900	6,900	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 collection requesting three years of approval for 6,900 burden hours annually.

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Annual Cost to Federal Government: $462,739

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? 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: 05/15/2025

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