Bright Futures for Women's Health and Wellness

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 003_BFWHWEmWell_fo Bright Futures for Women's Health and Wellness - Focus Groups	Form and Instruction	New	Available
Form 002_BFWHWEmWell_Di Bright Futures for Women's Health and Wellness - Distributor Survey	Form	New	Available
Form 001_BFWHWEmWellCon Bright Futures for Women's Health and Wellness - Consumer Survey	Form	New	Available
BFWHW Provider Survey10-14-09 w mbr edits.pdf	Supplementary Document	Uploaded 2009-11-09	Available
BFWHW Consumer Survey-10-21-09.pdf	Supplementary Document	Uploaded 2009-11-09	Available
HRSA Response to OMB_10_27_09.pdf	Supplementary Document	Uploaded 2009-11-09	Available
ss_Bright Futures_NEW_Part B.pdf	Supporting Statement B	Uploaded 2009-07-21	Available
Appendices_Bright Futures_NEW.pdf	Supplementary Document	Uploaded 2009-07-21	Available
ss_Bright Futures_NEW_Part A_updated 11-9-09.pdf	Supporting Statement A	Uploaded 2009-11-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
190118	Bright Futures for Women's Health and Wellness - Focus Groups	Form and Instruction	New
190117	Bright Futures for Women's Health and Wellness - Distributor Survey	Form	New
190116	Bright Futures for Women's Health and Wellness - Consumer Survey	Form	New

ICR Details

OMB Control No: 0915-0329	ICR Reference No: 200907-0915-003
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: 11/13/2009
	Date Received in OIRA: 07/29/2009
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2011	24 Months From Approved
Responses	667	0	0
Time Burden (Hours)	247	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Health Resources and Services Administration (HRSA), Office of Women's Health (OWH) is requesting OMB approval for the intermediate evaluation of the Bright Futures for Women's Health and Wellness (BFWHW) Initiative's Emotional Wellness Guides for women. This data collection activity is designed to gather information that will be used to determine the utility of the BFWHW emotional wellness materials for women. The materials were developed to provide women with information on emotional wellness and to facilitate conversations with health care providers. This project will assess the utilization of these materials and will obtain feedback from women and health care providers.

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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

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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:
	74 FR 22556	05/13/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	74 FR 34759	07/17/2009
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
Bright Futures for Women's Health and Wellness - Consumer Survey	001_BFWHWEmWellCon	001_BFWHWEmWellCon
Bright Futures for Women's Health and Wellness - Distributor Survey	002_BFWHWEmWell_Dist	002_BFWHWEmWell_Dist
Bright Futures for Women's Health and Wellness - Focus Groups	003_BFWHWEmWell_focus	003_BFWHWEmWell_focus

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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	667	0	0	667	0	0
Annual Time Burden (Hours)	247	0	0	247	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 information collection activity.

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Annual Cost to Federal Government: $99,494

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: 07/29/2009

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