OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System

ICR 201301-0920-004 · OMB 0920-0612 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Progress Report Form Modified Repair queued
0920-0612 SS Part B 10 26 2012.doc Supporting Statement B Uploaded 2012-12-12 Available
Attachment 8 Consent Guidance 09 30 2012.doc Supplementary Document Uploaded 2012-12-12 Repair queued
Attachment 7 WISEWOMAN Map.docx Supplementary Document Uploaded 2012-12-12 Repair queued
Attachment 6 Contact Info for WISEWOMAN Programs 09 30 2012.docx Supplementary Document Uploaded 2012-12-12 Available
Attachment 2b Summary of Public Comments.docx Supplementary Document Uploaded 2012-12-12 Available
Attachment 2a Federal Register Notice.pdf Supplementary Document Uploaded 2012-12-12 Repair queued
Attachment 1b 301PHSA.pdf Supplementary Document Uploaded 2012-12-12 Available
Attachment 1a PL 101.pdf Supplementary Document Uploaded 2012-12-12 Available
Attachment 4b Screen Shots of Portal.docx Supplementary Document Uploaded 2012-12-12 Repair queued
Attachment 3b Screen Shots of Portal.docx Supplementary Document Uploaded 2012-12-12 Repair queued
0920-0612 SS Part A 10 26 2012.doc Supporting Statement A Uploaded 2012-12-12 Available
IC Document Collections
IC IDCollectionTypeStatusForm
37802 Screening and Assessment Minimum Data Elements (MDEs) Instruction Modified
191867 Progress Report Form Modified
191866 Lifestyle Intervention Minimum Data Elements (MDEs) Instruction Modified
ICR Details
0920-0612 201301-0920-004
Historical Active 201101-0920-002
HHS/CDC
Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System
Extension without change of a currently approved collection   No
Regular
Approved without change 01/31/2013
Retrieve Notice of Action (NOA) 01/04/2013
  Inventory as of this Action Requested Previously Approved
01/31/2014 12 Months From Approved 03/31/2013
126 0 126
1,680 0 1,680
0 0 0
CDC requests a one year extension to collect information from WISEWOMAN grantees about activities to be conducted in the final year of the current cooperative agreement. The information collection consists of grantees progress reports and minumum data elements that describe the screening, assessment, and lifestyle intervention services provided to women through the WISEWOMAN program.
PL: Pub.L. 101 - 354 300n-4a Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  77 FR 62515 10/15/2012
77 FR 76044 12/26/2012
Yes
  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 126 126 0 0 0 0
Annual Time Burden (Hours) 1,680 1,680 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No
$356,789
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Tony Richardson 404 639-4965 [email protected]
  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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
01/04/2013