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

Forms and Documents

Document Name	Status
WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction	Modified
Annual Progress Report Form and Instruction	Modified
Att 7 Consent Guidance.pdf Supplementary Document	2022-08-11
60-day FRN_06022022.pdf Supplementary Document	2022-08-11
Att 2b WISEWOMAN Prg Mgrs Dirs Data Mgrs.pdf Supplementary Document	2022-08-11
Att 2a WISEWOMAN Awardees Map.png Supplementary Document	2022-08-11
Att 1b Sec 301 PHSA.pdf Supplementary Document	2022-08-11
Att 1a NBCCEDP Law Statute.pdf Supplementary Document	2022-08-11
0920-0612 SSB_08032022.docx Supporting Statement B	2022-08-11
0920-0612 SSA_08032022.docx Supporting Statement A	2022-08-11

IC Document Collections

IC ID	Document Title	Status
37802	WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction	Modified
191867	Annual Progress Report Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0612	ICR Reference No: 202208-0920-002
Status: Received in OIRA	Previous ICR Reference No: 202010-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-0612
Title: Well-Integrated Screening and Evaluation for Women Across the Nation (WISEWOMAN) Reporting System
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular	Date Submitted to OIRA: 08/16/2022

	Requested	Previously Approved
Expiration Date	24 Months From Approved	08/31/2022
Responses	105	105
Time Burden (Hours)	2,240	2,240
Cost Burden (Dollars)	0	0

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Abstract: Well-Integrated Screening and Evaluation for Women Across the Nation, sponsored by CDC, provides cardiovascular disease risk reduction services to low income, uninsured, or underinsured women aged 40-64. There are no changes to the information collected. CDC will continue to use the information collected from WISEWOMAN awardees to support program monitoring and improvement activities, evaluation, and assessment of program outcomes. The information collection consists of two parts, a Progress Report and Minimum Data Elements. A two-year extension is requested.

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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:
	87 FR 33487	06/02/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 49848	08/12/2022
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
Annual Progress Report	None	WISEWOMAN Annual Progress Report
WISEWOMAN Program Minimum Data Elements (MDE)	None	Specifications for WISEWOMAN Minimum Data Elements (MDE Manual)

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ICR Summary of Burden

	Total Request	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	105	105	0	0	0	0
Annual Time Burden (Hours)	2,240	2,240	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: $384,750

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? No

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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: 08/16/2022

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