Bright Futures for Women's Health and Wellness

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
bfwhw passback final.doc	Supplementary Document	Uploaded 2007-09-20	Available
ss part b Bright Futures.doc	Supporting Statement B	Uploaded 2007-05-10	Available
ss bright futures.DOC	Supporting Statement A	Uploaded 2007-05-15	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
180333	Bright Futures for Women's Health and Wellness	Instruction	New
180332	Bright Futures for Women's Health and Wellness	Instruction	New
180331	Bright Futures for Women's Health and Wellness	Other-Provider survey	New
180330	Bright Futures for Women's Health and Wellness	Other-Adult Women Survey	New

ICR Details

OMB Control No: 0915-0308	ICR Reference No: 200705-0915-007
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HSA	Agency Tracking No:
Title: Bright Futures for Women's Health and Wellness
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: 09/20/2007
	Date Received in OIRA: 05/29/2007
Terms of Clearance: This ICR is approved consistent with memo of 9/17/07. HRSA agrees to provide an incentive no greater than $350 per site, to revise the instruments for greater clarity and to maximize the practical utility of the data collected, and to disclose all study limitations along with any publication of results.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2009	06/30/2009
Responses	3,072	0	0
Time Burden (Hours)	3,196	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: This data collection activity is designed to gather information that will be used to determine the utility of the Bright Future's for Women's Health and Wellness (BFWHW) physical activity and healthy eating materials for women. The materials were developed to provide women with information on dietary and physical activity behaviors and to facilitate conversations with health care providers aimed at setting goals for healthy physical activity and healthy eating. This project will assess the utilization of these materials and will obtain feedback from women and health care providers.

---

Authorizing Statute(s): PL: Pub.L. 101 - 239 501 Name of Law: Maternal and Child Health Services Block Grant
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 5446	02/06/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 26639	05/10/2007
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Bright Futures for Women's Health and Wellness
Bright Futures for Women's Health and Wellness
Bright Futures for Women's Health and Wellness
Bright Futures for Women's Health and Wellness

---

ICR Summary of Burden

table that charts list 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	3,072	0	0	3,072	0	0
Annual Time Burden (Hours)	3,196	0	0	3,196	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: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new project.

---

Annual Cost to Federal Government: $136,740

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

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

---

Common Form ICR:  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:

(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: 05/29/2007

---