The National Bone Health Campaign Pilot Site Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-NBHC_OMB clearance supporting statement_Section B_020909.doc	Supporting Statement B	Uploaded 2009-02-09	Available
0990-Evaluation National Bone.doc	Supporting Statement A	Uploaded 2009-02-25	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
188223	Colition Post Test Survey	Other-questionnaire	New
188222	Coalition Pretest Survey	Other-questionnaire	New
188221	Facilitator Feedback Forms (10 forms)	Other-questionnaire	New
188220	Adolescent Post test questionnaire	Other-questionnaire	New
188219	Adolescent Pretest Questionnaire	Other-questionnaire	New
188218	Adolescent Session Evaluation Form (10 forms)	Other-questionnaire	New
188217	Adolescent Post test Questionnaire	Other-survey	New
188216	Adolescent Pretest	Other-questionnaire	New
188215	Parent/Caregiver Post test Questionnaire	Other-questionnaire	New
188214	Parent/Caregiver Pretest Questionnaire	Other-questionnaire	New
188213	Parent/Caregiver Sessison Evaluation Forms (10 Forms)	Other-questionnaire	New
188212	Parent/Caregiver Post test	Other-questionnaire	New
188211	Parent/caregiver Pre-test Questionnaire	Other-Questionnaire	New

ICR Details

OMB Control No: 0990-0337	ICR Reference No: 200903-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: The National Bone Health Campaign Pilot Site Project
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 without change	Conclusion Date: 06/04/2009
	Date Received in OIRA: 03/04/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	06/30/2012	36 Months From Approved
Responses	4,930	0	0
Time Burden (Hours)	755	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This request is for a new approval of data collected as part of a new national bone health campaign pilot site project. The Office on Women's Health (OWH) and its contractors are working to plan, implement, and evaluate a community-based pilot program as part of its efforts to increase bone-healthy behaviors through the National Bone Health Campaign (NBHC).

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Authorizing Statute(s): US Code: 42 USC 306 Name of Law: Public Health Service Act
  

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:
	73 FR 72803	12/01/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 7602	02/18/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Parent/caregiver Pre-test Questionnaire
Parent/Caregiver Post test
Parent/Caregiver Sessison Evaluation Forms (10 Forms)
Parent/Caregiver Pretest Questionnaire
Parent/Caregiver Post test Questionnaire
Adolescent Pretest
Adolescent Post test Questionnaire
Adolescent Session Evaluation Form (10 forms)
Adolescent Pretest Questionnaire
Adolescent Post test questionnaire
Facilitator Feedback Forms (10 forms)
Coalition Pretest Survey
Colition Post Test Survey

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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	4,930	0	0	4,930	0	0
Annual Time Burden (Hours)	755	0	0	755	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: $348,700

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)? No

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: 03/04/2009

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