Information Collection Request
[NCCDPHP] Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System
ICR 202304-0920-005 · OMB 0920-0612 · Received in OIRA
⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0612 can be found here:
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920-0612 WISEWOMAN Program Minimum Data Elements (MDE) |
Form and Instruction | Modified | Repair queued |
| Annual Progress Report |
Form and Instruction | Unchanged | Repair queued |
 OMB Change Request_04182023.docx |
Justification for No Material/Nonsubstantive Change | Uploaded 2023-04-18 | Repair queued |
 Att 7 Consent Guidance.pdf |
Supplementary Document | Uploaded 2022-08-11 | Repair queued |
| 60-day FRN_06022022.pdf |
Supplementary Document | Uploaded 2022-08-11 | Missing upstream |
| Att 2b WISEWOMAN Prg Mgrs Dirs Data Mgrs.pdf |
Supplementary Document | Uploaded 2022-08-11 | Missing upstream |
 Att 2a WISEWOMAN Awardees Map.png |
Supplementary Document | Uploaded 2022-08-11 | Repair queued |
| Att 1b Sec 301 PHSA.pdf |
Supplementary Document | Uploaded 2022-08-11 | Repair queued |
| Att 1a NBCCEDP Law Statute.pdf |
Supplementary Document | Uploaded 2022-08-11 | Repair queued |
| 0920-0612 SSB_08032022.docx |
Supporting Statement B | Uploaded 2022-08-11 | Missing upstream |
| 0920-0612 SSA_08032022.docx |
Supporting Statement A | Uploaded 2022-08-11 | Repair queued |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 37802 |  WISEWOMAN Program Minimum Data Elements (MDE) |
Form and Instruction | Modified | |
| 191867 | Annual Progress Report |
Form and Instruction | Unchanged |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-0612 |
| Type of Information Collection | No material or nonsubstantive change to a currently approved collection |
| Previous ICR Reference No | 202208-0920-002 |
| Agency Tracking No | 0920-0612-23EG |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |