National Community Centers of Excellence in Women's Health and National Centers of Excellence in Women's Health Joint Project Evaluation/Participant Survey

Forms and Documents

Document	Type	Status	Availability

No forms / supporting documents in this ICR. Check IC Document Collections.

IC Document Collections

IC ID	Collection	Type	Status	Form
10430	National Community Centers of Excellence in Women's Health and National Centers of Excellence in Women's Health Joint Project Evaluation/Participant Survey		Migrated

ICR Details

OMB Control No: 0990-0296	ICR Reference No: 200511-0990-002
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: National Community Centers of Excellence in Women's Health and National Centers of Excellence in Women's Health Joint Project Evaluation/Participant Survey
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/06/2006
	Date Received in OIRA: 11/17/2005
Terms of Clearance: Approved consistent with the following terms of clearance: consistent with HHS memo submitted to OMB 01/31/06 this collection of information is not meant to assess the health status of any given group in an given community; the data is instead meant to be used for purposes of program planning, this collection is approved consistent with HHS memo of 02/03/06 addressing confidentiality as soon as possible but no later than 02/10/06 HHS shall submit final language for inclusion in the public docket prior to initiating any components of the collection. This collection of information is being conducted in conjunction with OMB control No. 0990-0297.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2009	02/28/2009
Responses	390	0	0
Time Burden (Hours)	98	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Women (patients/community members) who participated in a joint project program will complete a survey sharing their perceptions of the program's impact on their knowledge or health. This will help evaluate the process and outcomes of the joing projects and their ability to provide integrated services to women.

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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:

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
National Community Centers of Excellence in Women's Health and National Centers of Excellence in Women's Health Joint Project Evaluation/Participant Survey

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ICR Summary of Burden

	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	390	0	0	390	0	0
Annual Time Burden (Hours)	98	0	0	98	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $0

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 11/17/2005

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