Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment 2b. Summary of Public Comments.doc	Supplementary Document	Uploaded 2010-01-19	Repair queued
0920-0612 Non-Research Determination.rtf	Supplementary Document	Uploaded 2010-01-19	Repair queued
Attachment 6 WISEWOMAN Grantees.doc	Supplementary Document	Uploaded 2010-01-19	Repair queued
Attachment 7 Consent Guidance.doc	Supplementary Document	Uploaded 2010-01-19	Available
0920-0612 SS Final.doc	Supporting Statement A	Uploaded 2010-01-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
37802	Screening and Assessment Minimum Data Elements (MDEs)	Instruction	Modified
191867	Progress Report	Instruction	New
191866	Intervention Minimum Data Elements (MDEs)	Instruction	New

ICR Details

OMB Control No: 0920-0612	ICR Reference No: 201001-0920-007
Status: Historical Active	Previous ICR Reference No: 200611-0920-004
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/26/2010
	Date Received in OIRA: 01/27/2010
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	36 Months From Approved	03/31/2010
Responses	126	0	150
Time Burden (Hours)	1,680	0	2,160
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the WISEWOMAN program is to reduce cardiovascular disease (CVD) risk factors among at-risk women. CDC collects evaluation information from grantees semi-annually, including data about the risk factors of women served, the interventions in which they participated, and program cost and progress information. The women served through the WISEWOMAN program also participate in the National Breast and Cervical Cancer Early Detection Program.

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Authorizing Statute(s): PL: Pub.L. 101 - 354 300n-4a Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
   US Code: 42 USC 301 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:
	74 FR 52492	10/13/2009
30-day Notice:	Federal Register Citation:	Citation Date:
	75 FR 3737	01/22/2010
Did the Agency receive public comments on this ICR? Yes

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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
Screening and Assessment Minimum Data Elements (MDEs)
Intervention Minimum Data Elements (MDEs)
Progress Report

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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	126	150	0	-24	0	0
Annual Time Burden (Hours)	1,680	2,160	0	-480	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: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: There will be a net decrease in the total annualized burden hours. Although the number of funded grantees will increase from 15 to 21, the burden per respondent will decrease due to changes in the data collection plan. First, the collection of cost information will be discontinued. Second, the frequency of data collection for some items will decrease from a quarterly schedule to a semi-annual schedule. This change will result in a consistent semi-annual reporting schedule for all information reported by WISEWOMAN grantees.

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Annual Cost to Federal Government: $329,706

Does this IC contain surveys, censuses, or employ statistical methods? No

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

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: 01/27/2010

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