Evaluation of the Office on Women's Health (OWH) Coalition for a Healthier Community (CHC) Initiative

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
0990-CHC_Rev7-MayaTech_IRB_Package with Core Instruments August 3 2015(4)-COR comments 8-5-2015 (00000003).doc	Supplementary Document	Uploaded 2015-11-05	Available
0990-OWH CHC Evaluation-Section B Statistical Methods.doc	Supporting Statement B	Uploaded 2015-11-05	Available
0990-chc ss.docx	Supporting Statement A	Uploaded 2015-10-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218884	4--Grantee Annual Report on Coalition Functioning, Cost-Effectiveness, and Sustainability Planning	Other-report	New
218883	Coalition participants, and other community members online survey	Other-survey	New
218882	Coalition members, and community leaders online survey	Other-survey	New
218698	Discussion Guide for Telephone Interviews	Other-guide	New

ICR Details

OMB Control No: 0990-0443	ICR Reference No: 201508-0990-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Evaluation of the Office on Women's Health (OWH) Coalition for a Healthier Community (CHC) Initiative
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 without change	Conclusion Date: 02/22/2016
	Date Received in OIRA: 11/05/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2019	36 Months From Approved
Responses	910	0	0
Time Burden (Hours)	457	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: OWH is seeking to collect core data across grantees to examine the extent to which the Government's investment has resulted in achieving OWH-related Healthy People 2020 priorities and yields lessons learned upon which to plan future initiatives related to its mission. The proposed collection includes plans for interviews and surveys with staff, volunteers, and program participants in the 10 communities where the grants were funded; and review of secondary data sources such as progress and annual reports.

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Authorizing Statute(s): None

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:
	80 FR 50015	08/18/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 68545	11/05/2015
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Discussion Guide for Telephone Interviews
Coalition members, and community leaders online survey
Coalition participants, and other community members online survey
4--Grantee Annual Report on Coalition Functioning, Cost-Effectiveness, and Sustainability Planning

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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	910	0	0	910	0	0
Annual Time Burden (Hours)	457	0	0	457	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: $117,239

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: 11/05/2015

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