OWH Evaluation of Women's Health Leadership Institute Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Attachment 27_Email Invitation for Telephone Interview (Stakeholders)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
30day Federal Register, Volume 81 Issue 163 (Tuesday, August 23, 2016).htm	Supplementary Document	Uploaded 2016-08-25	Available
Attachment 26_Phone Invitation for Telephone Interview (Stakeholders)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Repair queued
Attachment 25_Email Invitation for Telephone Interview (Supervisors)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 24_Phone Invitation for Telephone Interview (Supervisors)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 23_Email Invitation for Telephone Interview (MTs)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 22_Phone Invitation for Telephone Interview (MTs)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 21_Email Invitation for Telephone Interview (CHWs)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 20_Phone Invitation for Telephone Interview (CHWs)_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 19_Voicemail and Callback Script for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 18_Telephone Prompting Script for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 17_Reminder Postcard for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 15_Initial Mail Invitation for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 16_Outer Envelope for Survey.docx	Supplementary Document	Uploaded 2016-08-25	Available
Attachment 14_Reminder Email 2 for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 13_Reminder Email 1 for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 10_Worksite Supervisor Interview Protocol.docx	Supplementary Document	Uploaded 2016-08-25	Available
Attachment 12_Initial Email Invitation for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 6_IRB Letter.pdf	Supplementary Document	Uploaded 2016-08-25	Available
Attachment 5_Verbal Informed Consent for Telephone Interview_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 4_Informed Consent for Survey_FINAL.docx	Supplementary Document	Uploaded 2017-03-03	Available
Attachment 3_Final OWH WHLI Program Evaluation Survey Pilot Report.docx	Supplementary Document	Uploaded 2016-08-25	Available
60-day FRN_Evaluation of the Women's (Friday, April 29, 2016).htm	Supplementary Document	Uploaded 2016-08-25	Available
Attachment 1_Public Health Service Law sec 301.docx	Supplementary Document	Uploaded 2016-08-25	Available
0990-WHLI_SS_B.docx	Supporting Statement B	Uploaded 2016-08-24	Available
_WHLI OMB Supporting Statement_FINAL.docx	Supporting Statement A	Uploaded 2017-03-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
223184	Telephone Interviews- Community Stakeholders	Other-interview	New
223183	Telephone Interviews-CHW Worksite Supervisors	Other-interview	New
223182	Telephone Interviews-Master Trainers	Other-interview	New
223180	Telephone Interviews-CHWs with completed CAPs or other leadership activities	Other-interview	New
223179	Online Survey-All CHWs	Other-survey	New

ICR Details

OMB Control No: 0990-0455	ICR Reference No: 201604-0990-004
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: OWH Evaluation of Women's Health Leadership Institute 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: 03/06/2017
	Date Received in OIRA: 08/26/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2020	36 Months From Approved
Responses	520	0	0
Time Burden (Hours)	225	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This evaluation supports the mission and strategic plan for both HHS and OWH. The study supports the HHS strategic goal of “advancing scientific knowledge and innovation.” Specifically, this evaluation addresses objective D by, “increasing our understanding of what works in public health and human services practice.” In addition, the evaluation supports the HHS strategic goal of “ensuring efficiency, accountability, and effectiveness of HHS programs.” The evaluation results are critical to measuring the efficacy of the use of government funds. The evaluation results will also help OWH with planning and developing future training initiatives and supports the OWH strategic goals of informing and advancing policies as well as identifying, testing and promoting effective programs for women and girls.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: U.S. 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:
	81 FR 25681	04/29/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 57594	08/23/2016
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
Online Survey-All CHWs
Telephone Interviews-CHW Worksite Supervisors
Telephone Interviews- Community Stakeholders
Telephone Interviews-CHWs with completed CAPs or other leadership activities
Telephone Interviews-Master Trainers

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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	520	0	0	520	0	0
Annual Time Burden (Hours)	225	0	0	225	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: $199,500

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]? Yes

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: 08/26/2016

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