Information Collection Request

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

ICR 202502-0920-014 · OMB 0920-0612 · Received in OIRA

Forms and Documents
DocumentTypeStatusAvailability
Form 0920-0612 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction Modified Repair queued
Annual Progress Report Form and Instruction Modified Repair queued
Attachment 9 Summary Exhibits_Minor Changes_04082025.pdf Supplementary Document Uploaded 2025-04-08 Repair queued
WISEWOMAN 0920-0612 SSB F_Updated_04072025.docx Supporting Statement B Uploaded 2025-04-08 Repair queued
WISEWOMAN 0920-0612 SSA F_Updated_04072025.docx Supporting Statement A Uploaded 2025-04-08 Repair queued
WISEWOMAN SPD-15 Justification.docx Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 1b WISEWOMAN Program Managers Directors and Data Managers.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 5b Web Portal Upload Screen Shot.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 5a Web Portal Login Screen.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 7b_WISEWOMANFederalRegisterNotice2024.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
Attachment 1a Map of WISEWOMAN Awardees.pdf Supplementary Document Uploaded 2025-03-12 Repair queued
OMB Change Request_08182023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-08-22 Missing upstream
OMB Change Request_04182023.docx Justification for No Material/Nonsubstantive Change Uploaded 2023-04-18 Missing upstream
Att 7 Consent Guidance.pdf Supplementary Document Uploaded 2022-08-11 Missing upstream
60-day FRN_06022022.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
Att 2b WISEWOMAN Prg Mgrs Dirs Data Mgrs.pdf Supplementary Document Uploaded 2022-08-11 Repair queued
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
IC Document Collections
IC IDCollectionTypeStatusForm
37802 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction Modified
191867 Annual Progress Report Form and Instruction Modified
ICR Details
0920-0612 202502-0920-014
Received in OIRA 202308-0920-009
HHS/CDC 0920-0612
[NCCDPHP] Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System
Reinstatement with change of a previously approved collection   No
Regular 06/25/2025
  Requested Previously Approved
36 Months From Approved
120 0
2,640 0
0 0

The WISEWOMAN program focuses on reducing risk factors for cardiovascular disease (CVD) among at-risk participants. Addressing risk factors such as high blood pressure, elevated blood cholesterol, obesity, sedentary lifestyle, diabetes, and smoking, reduces a woman’s risk of CVD-related illness and death. CVD, is a primary contributor to mortality, morbidity, and decreased quality of life, especially among older participants. Health United States (2019) reported that CVD was the leading cause of death for women in the United States. Participants in lower income brackets, or without health insurance have an increased risk of CVD morbidity and mortality, because they have limited access to health services such as screenings, medications, healthy behavior support services to manage their risk factors. State, and tribal organizations awarded with WISEWOMAN grants are expected to report information pertaining to the aforementioned factors for the purposes of program evaluation. The WISEWOMAN program shares 8 data elements with the National Breast and Cervical Cancer Early Detection Program (NBCCEDP) so the burden of collecting additional information by awardees (see Attachment 3) is minimized. Overall, there are no changes to the number of awardees (respondents), the information collection requirements, the estimated burden per response, or the total estimated annualized burden hours. This Revision request for WISEWOMAN Program replaces the current race MDE with OMB 2024 Statistical Policy Directive-15 Standard (Figure 2). Two additional questions from the PRAPARE Screening Tool will be added for program fidelity and data quality.

US Code: 42 USC 241 Name of Law: Public Health Service Act
   PL: Pub.L. 101 - 354 300 Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
  
None

Not associated with rulemaking

  89 FR 85213 10/25/2024
90 FR 24612 06/11/2025
Yes

  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 120 0 0 0 0 120
Annual Time Burden (Hours) 2,640 0 0 0 0 2,640
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$382,756
Yes Part B of Supporting Statement
    No
    No
No
No
No
No
Jeffrey Zirger 404 639-7118 [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.
06/25/2025