[NCCDPHP] WISEWOMAN National Program Evaluation

ICR 202211-0920-004

OMB: 0920-1279

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1279 Site Visit Discussion Guide - Administrators Form	Modified
Form 0920-1279 Program Survey Form	Modified
30dy231279.published.pdf Supplementary Document	2022-12-13
Attachment G Expedited Review Approved_ IRB #612MPR19.pdf Supplementary Document	2022-12-05
Attachment F1 0920-1279 60 day Aug22-2022.pdf Supplementary Document	2022-12-05
Attachment E Consent form.docx Supplementary Document	2022-12-05
Attachment B Public Health Service Act.pdf Supplementary Document	2019-10-10
Attachment A BCC Mortality Prev Act of 1990.pdf Supplementary Document	2019-10-10
Support Statement B WISEWOMAN National Eval.docx Supporting Statement B	2022-12-13
Support Statement A WISEWOMAN National Eval 11_30_22.docx Supporting Statement A	2022-12-13

IC Document Collections

IC ID	Document Title	Status
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