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

Forms and Documents

Document Name	Status
Annual Progress Report Form	Unchanged
OMB Change Request Summary 04.06.18.docx Justification for No Material/Nonsubstantive Change	2018-04-11
Attachment 8 Consent Guidance.pdf Supplementary Document	2016-11-02
Attachment 7 Map of WISEWOMAN Awardees.pdf Supplementary Document	2016-11-02
Attachment 6 WISEWOMAN Program Managers Directors and Data Managers.pdf Supplementary Document	2016-11-02
Attachment 2b 0920-0612 60-day FRN 07 26 2016.pdf Supplementary Document	2016-11-02
Attachment 2a 0920-0612 OMB Change Request Notice Of Action.pdf Supplementary Document	2016-11-02
Attachment 1b Section 301 of the PH Service Act.pdf Supplementary Document	2016-11-02
Attachment 1a NBCCEDP Law Statute.pdf Supplementary Document	2016-11-02
Supporting Statement-Part_B 0920-0612.docx Supporting Statement B	2016-11-02
Service_Delivery_Supporting_Statement-Part_A 0920-0612 (Revised 10 31) (Clean Copy).docx Supporting Statement A	2016-11-02

IC Document Collections

IC ID	Document Title	Status
37802	Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System Instruction	Modified
191867	Annual Progress Report Form	Unchanged

ICR Details

OMB Control No: 0920-0612	ICR Reference No: 201804-0920-005
Status: Historical Active	Previous ICR Reference No: 201611-0920-003
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0612 (18YZ)
Title: Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/03/2018
	Date Received in OIRA: 04/12/2018
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	12/31/2018	12/31/2018
Responses	63	0	63
Time Burden (Hours)	1,344	0	1,344
Cost Burden (Dollars)	0	0	0

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Abstract: CDC request OMB approval for a non-Substantive change to the approved WISEWOMAN information collection. The request is to modify the WISEWOMAN program's reporting system, used to both screen and monitor participants, as well as to evaluate and improve program efficacy. The proposed change is to the minimum data elements (MDE) part of system to improve data accuracy and analytical utility, as well as to streamline the questionnaire flow for respondents.

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Authorizing Statute(s): PL: Pub.L. 101 - 354 300 Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
   US Code: 42 USC 241 Name of Law: 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 48806	07/26/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 78158	11/07/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

IC Title	Form No.	Form Name
Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System	none, 0920-0612	WISEWOMAN data management system portal ,   WISEWOMAN Program MDE Manual Version 9.0 July 2013
Annual Progress Report	none	Annual Progress Report

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ICR Summary 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	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

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $370,250

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 04/12/2018

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