Living Healthier Living Longer Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Living Healthier Living Longer Web-based Data Collection.docx	Supplementary Document	Uploaded 2013-08-27	Available
19060 - ID Living Healthier Living Longer Part B Statistical Methods (1).docx	Supporting Statement B	Uploaded 2013-07-19	Available
19060_ID 0990-Living Healthier Living Longer for Living Healthier.docx	Supporting Statement A	Uploaded 2013-07-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207825	Focus Study (completion)	Other-focus group	New
207824	Focus Group (study midpoint)	Other-focus group	New
207823	Health History (Questionnarie)	Other-questionnaire	New
207822	Health Screening (physical measurement)	Other-screening	New
207821	Pedometer Profile	Other-profile	New
207820	Study Completion Survey	Other-survey	New
207819	Baseline Survey	Other-survey	New

ICR Details

OMB Control No: 0990-0413	ICR Reference No: 201307-0990-003
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 19060
Title: Living Healthier Living Longer Program
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: 09/09/2013
	Date Received in OIRA: 07/22/2013
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2015	36 Months From Approved
Responses	360	0	0
Time Burden (Hours)	129	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Department of Health and Human Services (HHS) Coordinating Committee on Lesbian, Gay, Bi-sexual and Transgender (LGBT) Issues has prioritized the collection of health data on LGBT populations. In response, OWH funded an initiative to "identify and test effective and innovative ways of reducing obesity in lesbian and bisexual women". This initiative, which will be implemented in a LBGT senior center in New York City, will include nutritional and physical fitness counseling and activities that build upon the IOM[1] Goal 1: Make physical activity an integral and routine part of life, and Goal 3: Transform messages about physical activity and nutrition. The program is based on cognitive-behavioral theory and will be tailored to overweight bisexual and lesbian women 60 years and over. The program will enroll a minimum of 40 older lesbian and bisexual women and will include 14 weekly peer-moderated sessions during which participants will engage in 10 minutes of physical activity (e.g., yoga), learn and perform a featured resistance-training exercise, learn about a featured fruit/vegetable/legume with supporting recipes, and participate in a group discussion on a pre-specified topic (e.g., goal-setting, cooking tips, exercise self-efficacy and coping mechanisms). Educational materials will accompany the weekly sessions. Participants will be provided with "Smart" pedometers that will automatically synchronize with an activated computer available at the intervention site, allowing for targeted goal setting using step counts, and online interaction among participants choosing to share their steps with others in the group. Participants will also be encouraged to participate in walking groups and other physical activity opportunities available at the senior center. Information will be gathered and analyzed with the objective of identifying and understanding the effects of this healthy weight intervention and to inform the applicability of the intervention to other sites across the United States. The project is scheduled for one year.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: 241 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:
	78 FR 15725	03/12/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 42946	07/18/2013
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
Baseline Survey
Study Completion Survey
Pedometer Profile
Health Screening (physical measurement)
Health History (Questionnarie)
Focus Group (study midpoint)
Focus Study (completion)

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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	360	0	0	360	0	0
Annual Time Burden (Hours)	129	0	0	129	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: New collection

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Annual Cost to Federal Government: $189,465

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]? 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: 07/22/2013

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