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 201310-0920-006 · OMB 0920-0612 · Historical Active

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0612 Combined MDE for Screening and Assessment MDE and Lifestyle Program MDE Form and Instruction Modified Available
0920-0612 Part B_09 24 2013.doc Supporting Statement B Uploaded 2013-10-21 Available
Attachment 7 Consent Guidance 09 11 2013_TC.doc Supplementary Document Uploaded 2013-10-30 Repair queued
Attachment 6 WISEWOMAN Programs 08 08 2013.doc Supplementary Document Uploaded 2013-10-30 Available
Attachment 2b Summary of Public Comments 07 22 2013.doc Supplementary Document Uploaded 2013-10-29 Repair queued
Attachment 4b Screen Shots of Portal.docx Supplementary Document Uploaded 2012-12-12 Repair queued
Attachment 4 Screen Shots of Portal 09 24 2013.pdf Supplementary Document Uploaded 2013-10-29 Available
0920-0612 Part A_09 24 2013.doc Supporting Statement A Uploaded 2013-10-21 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
37802 Combined MDE for Screening and Assessment MDE and Lifestyle Program MDE Form and Instruction Modified
191867 Annual Progress Report Instruction Modified
191866 Lifestyle Intervention Minimum Data Elements (MDEs) Instruction Removed
ICR Details
0920-0612 201310-0920-006
Historical Active 201301-0920-004
HHS/CDC 20700
Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System
Revision of a currently approved collection   No
Regular
Approved without change 12/02/2013
Retrieve Notice of Action (NOA) 10/30/2013
  Inventory as of this Action Requested Previously Approved
12/31/2016 36 Months From Approved 01/31/2014
63 0 126
1,344 0 1,680
0 0 0
CDC plans to collect information from 21 WISEWOMAN program awardees. In 2013 new cooperative agreements were awarded with modified reporting requirements that reflect CDC's increased emphasis on program outcomes. The information collection consists of grantee progress reports and minimum data elements (MDE) 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
  75 FR 31554 05/24/2013
78 FR 64502 10/29/2013
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 63 126 0 -42 -21 0
Annual Time Burden (Hours) 1,344 1,680 0 -336 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
Yes
Miscellaneous Actions
The overall burden will decrease due to a reduction in the frequency of progress reporting, from twice per year to once per year. The estimated burden per response for the progress report will not change. The estimated burden for MDE reporting will not change.
$372,198
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.
10/30/2013