WISEWOMAN Reporting System

ICR 200611-0920-004

OMB: 0920-0612

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Supplementary Document
2006-11-15
Supplementary Document
2006-11-15
Supplementary Document
2006-11-15
Supplementary Document
2006-11-15
Supporting Statement A
2006-11-15
IC Document Collections
IC ID
Document
Title
Status
37802 Modified
ICR Details
0920-0612 200611-0920-004
Historical Active 200605-0920-006
HHS/CDC
WISEWOMAN Reporting System
Extension without change of a currently approved collection   No
Regular
Approved without change 01/09/2007
Retrieve Notice of Action (NOA) 11/22/2006
  Inventory as of this Action Requested Previously Approved
01/31/2010 36 Months From Approved 01/31/2007
150 0 150
2,160 0 2,160
0 0 0

The Centers for Disease Control and Prevention is requesting an extension to continue to collect comprehensive cardiovascular disease screening and intervention services data collected by grantees funded through the Well-Integrated Screening and Evaluation for Women Across the National (WISEWOMAN) program. The purpose of the data collection is to evaluate the costs and effectiveness of the program.

PL: Pub.L. 101 - 354 300n-4a Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
  
None

Not associated with rulemaking

  71 FR 57512 09/29/2006
71 FR 66530 11/15/2006
Yes

1
IC Title Form No. Form Name
WISEWOMAN Reporting System 1 Wise woman Data User Manual

  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 150 150 0 0 0 0
Annual Time Burden (Hours) 2,160 2,160 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$360,000
No
No
Uncollected
Uncollected
Uncollected
Uncollected
Saleda Perryman

  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.
11/22/2006


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