The National Evaluation of the Rural/Frontier Women's Health Coordinator Center

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
OMB Memo - RFCC Evaluation (2).doc	Supplementary Document	Uploaded 2007-08-21	Available
RFCC.doc	Supporting Statement B	Uploaded 2007-01-25	Available
0990-Appendix J_Case Study Outline	Supplementary Document	Uploaded 2007-06-07	Available
0990-RFCC.doc	Supporting Statement A	Uploaded 2007-06-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
180725	RFCC Tracking Sheet	Other-forms	New
180724	RFCC Site Visit	Other-form	New
180723	RFCC Client/Patient Questionnaire	Other-forms	New
180722	RFCC Clinical Intake Form (Non-Provider RFCC)	Instruction	New
180721	RFCC Clinical Intake Form (Provider RFCCs)	Other-form	New
180720	RFCC Women's Services Registration Form	Other-womens questionnaire	New
180719	RFCC Leaders Director/Program Coordinator Questionnaire	Other-questionnaire	New

ICR Details

OMB Control No: 0990-0316	ICR Reference No: 200706-0990-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: The National Evaluation of the Rural/Frontier Women's Health Coordinator Center
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: 08/22/2007
	Date Received in OIRA: 06/13/2007
Terms of Clearance: Approved consistent with HHS changes outlined in Dept. memo and included in the public docket.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2010	36 Months From Approved
Responses	833	0	0
Time Burden (Hours)	470	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: Women residing in rural and frontier communities face many challenges in meeting their basic health care needs. As a result of numerous barriers, this vulnerable population is underserved and generally in a poorer state of health compared to women living in urban areas of the U.S. Evaluating the effectiveness of RFCCs is essential for determining whether these centers are the best vehicles for coordinating and leveraging new and existing resources for women's health in rural and frontier communities. The OWH is seeking to evaluate all eleven RFCCs.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
   PL: Pub.L. 109 - 346 241 Name of Law: null
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 6243	02/09/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	72 FR 21020	04/27/2007
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 7

table that charts list of burden

IC Title	Form No.	Form Name
RFCC Leaders Director/Program Coordinator Questionnaire
RFCC Women's Services Registration Form
RFCC Clinical Intake Form (Provider RFCCs)
RFCC Clinical Intake Form (Non-Provider RFCC)
RFCC Client/Patient Questionnaire
RFCC Site Visit
RFCC Tracking Sheet

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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	833	0	0	833	0	0
Annual Time Burden (Hours)	470	0	0	470	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 collection

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Annual Cost to Federal Government: $85,290

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

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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: 06/13/2007

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