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

ICR 202304-0920-005

OMB: 0920-0612

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-0612 WISEWOMAN Program Minimum Data Elements (MDE) Form and Instruction	Modified
Annual Progress Report Form and Instruction	Unchanged
OMB Change Request_04182023.docx Justification for No Material/Nonsubstantive Change	2023-04-18
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	Unchanged