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
0920-0612_ChangeRequest_01242011.doc	Justification for No Material/Nonsubstantive Change	Uploaded 2011-01-28	Available
0920-0612_ChangeRequest_12222010.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2010-12-23	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	Modified
191866	Intervention Minimum Data Elements (MDEs)	Instruction	Modified

ICR Details

OMB Control No: 0920-0612	ICR Reference No: 201101-0920-002
Status: Historical Active	Previous ICR Reference No: 201001-0920-007
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: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/31/2011
	Date Received in OIRA: 01/18/2011
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2013	03/31/2013	03/31/2013
Responses	126	0	126
Time Burden (Hours)	1,680	0	1,680
Cost Burden (Dollars)	0	0	0

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Abstract: CDC requests OMB approval to implement minor changes to the Screening and Assessment MDE and the Intervention MDE. No changes to the Progress Report are proposed. The program scope, purpose, burden, protocol, methodology, and planned analyses remain unchanged from the previous approval. 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

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
Progress Report
Screening and Assessment Minimum Data Elements (MDEs)	none	Revised Screening & Assessment MDEs
Intervention Minimum Data Elements (MDEs)	none	Revised Intervention MDEs

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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	126	0	0	0	0
Annual Time Burden (Hours)	1,680	1,680	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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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]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

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: 01/18/2011

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