Out, Proud and Healthy Fitness Project

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
121207_NORC FullBoardApproval_2013-02-20.pdf	Supplementary Document	Uploaded 2013-08-27	Available
OMB Appendix A_Enrollment.docx	Supplementary Document	Uploaded 2013-08-27	Available
MU HS IRB Approval Letter.pdf	Supplementary Document	Uploaded 2013-08-27	Available
0990-Part B Statistical Methods_Out Proud and Healthy Fitness Project_June 2013.docx	Supporting Statement B	Uploaded 2013-07-18	Available
19116_ID Out Proud and Healthy Fitness Project_June 2013 (2).docx	Supporting Statement A	Uploaded 2013-07-19	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207830	12-month Follow up Assessment Survey	Other-survey	New
207829	Post Intervention Focus Group	Other-survey	New
207828	4-month Follow up Assessment Survey	Other-survey	New
207827	Baseline Survey	Other-survey	New
207826	Enrollment Survey	Other-survey	New

ICR Details

OMB Control No: 0990-0411	ICR Reference No: 201307-0990-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 19116
Title: Out, Proud and Healthy Fitness 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 with change	Conclusion Date: 08/29/2013
	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	08/31/2015	36 Months From Approved
Responses	590	0	0
Time Burden (Hours)	470	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The Office of Women's Health (OWH) and 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" (HHS, 2012). OWH contracted with NORC and its subcontractor, the University of Missouri – Columbia (MU), to develop and pilot test a project entitled "Out Proud and Healthy Fitness Project (OPAH)." The intervention will promote health and fitness in lesbian and bisexual (LB) women through group support programs and community approaches tailored to sexual minority women. OPAH will address Goal 1, Make Physical Activity an Integral and Routine Part of Life, of the 2012 IOM report on Accelerating Progress in Obesity Prevention. To accomplish this, OPAH will partner with two Sexual and Gender Minority community centers in Missouri, The Center Project in Columbia and SAGE Metro St. Louis, in a randomized prevention study. Approximately 160 individuals will be enrolled in the study, for a target number of 120 individuals completing. Approximately 40-50 participants will be enrolled in each study arm (Full Gym Group, Smart Pedometer Group, and Health Education (control) Group). The active intervention phase of the project is 16 weeks (4 months). Data will be collected at Baseline, Month 4 and Month 12 (about 7 months after the completion of the intervention) through direct assessments and surveys of the participants. The project is scheduled for one year. The project will affect lesbian and bi-sexual women forty years and over.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: 241 Public 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 17674	03/22/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 42949	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: 5

table that charts list of burden

IC Title	Form No.	Form Name
Enrollment Survey
Baseline Survey
4-month Follow up Assessment Survey
Post Intervention Focus Group
12-month Follow up Assessment 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	590	0	0	590	0	0
Annual Time Burden (Hours)	470	0	0	470	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: $21,600

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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