Information Collection Request
[NCCDPHP] WISEWOMAN National Program Evaluation
ICR 202211-0920-004 · OMB 0920-1279 · Received in OIRA
Forms and Documents
| Document | Type | Status | Availability |
|---|---|---|---|
 Form 0920-1279 Site Visit Discussion Guide - Administrators |
Form | Modified | Repair queued |
| Form 0920-1279 Program Survey |
Form | Modified | Repair queued |
 30dy231279.published.pdf |
Supplementary Document | Uploaded 2022-12-13 | Missing upstream |
| Attachment G Expedited Review Approved_ IRB #612MPR19.pdf |
Supplementary Document | Uploaded 2022-12-05 | Repair queued |
| Attachment F1 0920-1279 60 day Aug22-2022.pdf |
Supplementary Document | Uploaded 2022-12-05 | Repair queued |
 Attachment E Consent form.docx |
Supplementary Document | Uploaded 2022-12-05 | Repair queued |
| Attachment B Public Health Service Act.pdf |
Supplementary Document | Uploaded 2019-10-10 | Missing upstream |
| Attachment A BCC Mortality Prev Act of 1990.pdf |
Supplementary Document | Uploaded 2019-10-10 | Repair queued |
| Support Statement B WISEWOMAN National Eval.docx |
Supporting Statement B | Uploaded 2022-12-13 | Repair queued |
| Support Statement A WISEWOMAN National Eval 11_30_22.docx |
Supporting Statement A | Uploaded 2022-12-13 | Missing upstream |
IC Document Collections
| IC ID | Collection | Type | Status | Form |
|---|---|---|---|---|
| 238086 |  Innovation Site Visit Discussion Guide - Providers |
Other-Discussion Guide | Unchanged | |
| 238085 | Site Visit Discussion Guide - Providers |
Other-Discussion Guide | Unchanged | |
| 238084 | Innovation Site Visit Discussion Guide - Support Staff |
Other-Discussion Guide | Unchanged | |
| 238083 | Site Visit Discussion Guide - Support Staff |
Other-Discussion Guide | Unchanged | |
| 238082 | Innovation Site Visit Discussion Guide - Partners |
Other-Discussion Guide | Unchanged | |
| 238081 | Site Visit Discussion Guide - Partners |
Other-Discussion Guide | Unchanged | |
| 238080 | Innovation Site Visit Discussion Guide - Administrators |
Other-Discussion Guide | Modified | |
| 238079 | Site Visit Discussion Guide - Administrators |
Form | Modified | |
| 238078 | Program Survey |
Form | Modified |
ICR Details
| Status | Received in OIRA |
|---|---|
| Agency/Subagency | HHS/CDC |
| OMB Control No | 0920-1279 |
| Type of Information Collection | Extension without change of a currently approved collection |
| Previous ICR Reference No | 201910-0920-001 |
| Agency Tracking No | 0920-1279 |
| Date Submitted to OIRA | 1969-12-31 |
| Requested Expiration Date | 1969-12-31 |