Women's Preventive Health Services Survey

ICR 201702-0920-004

OMB: 0920-1200

Federal Form Document

IC Document Collections
ICR Details
0920-1200 201702-0920-004
Historical Active
HHS/CDC 16AWP
Women's Preventive Health Services Survey
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 10/27/2017
Retrieve Notice of Action (NOA) 03/02/2017
  Inventory as of this Action Requested Previously Approved
10/31/2020 36 Months From Approved
5,566 0 0
1,243 0 0
0 0 0

The goal of this study is to assess use of clinical preventive services, facilitators and barriers to use of clinical preventive services, and the ability to maintain consistent health insurance coverage among newly insured women who previously received cancer screenings through the National Breast and Cervical Cancer Early Detection Program. Results will inform how public health programs can support low-income medically underserved women to ensure they receive appropriate preventive health care services.

PL: Pub.L. 101 - 354 1501 Name of Law: Breast and Cervical Cancer Mortality Prevention Act
  
None

Not associated with rulemaking

  81 FR 52868 08/10/2016
82 FR 12356 03/02/2017
No

2
IC Title Form No. Form Name
Women's Preventive Health Services Survey none, none, none WPHSS questionnaire ,   Survey screenshots - English ,   Survey screenshots - Spanish
Eligibility Screener

  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 5,566 0 0 5,566 0 0
Annual Time Burden (Hours) 1,243 0 0 1,243 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0
Yes
Miscellaneous Actions
No
This is a new ICR.

$448,244
Yes Part B of Supporting Statement
    Yes
    No
No
No
No
Uncollected
Shari Steinberg 404 639-4942 [email protected]

  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.
03/02/2017


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