WHAM: Women Health and Mindfulness Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
RTI_LMHS_OMB_Attachments_Cover Sheet_august2013.docx	Supplementary Document	Uploaded 2013-08-27	Available
WHAM Study_SORN and privacy issues.docx	Supplementary Document	Uploaded 2013-08-27	Available
19144 Section B Statistical Methods- (WHAM) Womens Health and Mindfulness Program 30 day notice_28june2013.docx	Supporting Statement B	Uploaded 2013-07-22	Available
19144_ID (WHAM) Womens Health and Mindfulness Program.docx	Supporting Statement A	Uploaded 2013-07-22	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
207864	Evaluation Questionnaire: Follow-up month 8	Other-survey	New
207863	Interim Behavioral Assessment Month 5	Other-survey	New
207862	Evaluation Questionnaire: Follow-up-month 4	Other-questionnaire	New
207861	Accelerometer: Activity Diary and Reminder	Other-survey	New
207860	Baseline Interim Behavioral Assessment Month	Other-questionnaire	New
207859	Evaluation Questionnaire	Other-Questionnaire	New
207858	Group Intervention Sereening Questionnaire	Other-Consent	New
207857	Knowledge and Attitudes Assessment (Post-training)	Other-survey	New
207856	Knowledge and attitudes assessment (Pretraining)	Other-training	New

ICR Details

OMB Control No: 0990-0414	ICR Reference No: 201307-0990-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No: 19144
Title: WHAM: Women Health and Mindfulness 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: 07/23/2013
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	560	0	0
Time Burden (Hours)	179	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). The Women's Health and Mindfulness (WHAM) program developed in San Francisco, aims to test interventions that promote healthy weight in lesbian and bisexual (LB) women age 40 years and older on two levels.

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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 17209	03/20/2013
30-day Notice:	Federal Register Citation:	Citation Date:
	78 FR 42950	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: 9

table that charts list of burden

IC Title	Form No.	Form Name
Knowledge and attitudes assessment (Pretraining)
Knowledge and Attitudes Assessment (Post-training)
Group Intervention Sereening Questionnaire
Evaluation Questionnaire
Baseline Interim Behavioral Assessment Month
Accelerometer: Activity Diary and Reminder
Evaluation Questionnaire: Follow-up-month 4
Interim Behavioral Assessment Month 5
Evaluation Questionnaire: Follow-up month 8

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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	560	0	0	560	0	0
Annual Time Burden (Hours)	179	0	0	179	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: $238,250

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: 07/23/2013

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