Form 0920-0612 Annual Progress Report

Form Approved
OMB No. 0920-0612
Expiration date: 12/31/2018

Well-Integrated Screening and Evaluation for Woman Across the Nation (WISEWOMAN)
CURRENT BUDGET PERIOD ACTIVITIES/OBJECTIVES PROGRESS

Program Name:
Grantees Name:
Date of Progress Report:
Funding Opportunity #:
Award # and FY #:
Funding Period of Report:

SUMMARY STATEMENT:

PROGRAM MANAGEMENT OBJECTIVES:
 State programs individual objectives
 Status of meeting the objectives

Public reporting burden of this collection of information is estimated to average 16 hours per response,
including the time for reviewing instructions, searching existing data sources, gathering and maintaining the
data needed, and completing and reviewing the collection of information. An agency may not conduct or
sponsor, and a person is not required to respond to a collection of information unless it displays a currently
valid OMB control number. Send comments regarding this burden estimate or any other aspect of this
collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance
Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0612).

DIRECT SERVICE OBJECTIVES:
 State programs individual objectives
 Status of meeting the objectives

PARTNERSHIP OBJECTIVES:



State programs individual objectives
Status of meeting the objectives

EVALUATION OBJECTIVES:
 State programs individual objectives
 Status of meeting the objectives

CURRENT BUDGET PERIOD FINANCIAL PROGRESS: