Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System

ICR 201608-0920-004

OMB: 0920-0612

Federal Form Document

Forms and Documents
Document
Name
Status
Form and Instruction
Modified
Justification for No Material/Nonsubstantive Change
2016-08-09
Supporting Statement B
2013-10-21
Supplementary Document
2013-10-30
Supplementary Document
2013-10-30
Supplementary Document
2013-10-29
Supplementary Document
2012-12-12
Supplementary Document
2013-10-29
Supporting Statement A
2013-10-21
ICR Details
0920-0612 201608-0920-004
Historical Active 201310-0920-006
HHS/CDC 16AWO
Well-Integrated Screening and Evaluation for Women Across the Nation(WISEWOMAN) Reporting System
No material or nonsubstantive change to a currently approved collection   No
Regular
Approved without change 08/10/2016
Retrieve Notice of Action (NOA) 08/10/2016
  Inventory as of this Action Requested Previously Approved
12/31/2016 12/31/2016 12/31/2016
63 0 63
1,344 0 1,344
0 0 0

CDC plans to collect information from 21 WISEWOMAN program awardees. In 2013 new cooperative agreements were awarded with modified reporting requirements that reflect CDC's increased emphasis on program outcomes. The information collection consists of grantee progress reports and minimum data elements (MDE) that describe the screening, assessment, and lifestyle intervention services provided to women through the WISEWOMAN program.

PL: Pub.L. 101 - 354 300n-4a Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  
None

Not associated with rulemaking

  75 FR 31554 05/24/2013
78 FR 64502 10/29/2013
Yes

  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 63 63 0 0 0 0
Annual Time Burden (Hours) 1,344 1,344 0 0 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
No
No

$372,198
Yes Part B of Supporting Statement
Yes
No
No
No
Uncollected
Thelma Sims 4046394771

  No

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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
08/10/2016


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