View Information Collection Request (ICR) Package
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Please note that the OMB number and expiration date may not have been determined when this Information Collection Request and associated Information Collection forms were submitted to OMB. The approved OMB number and expiration date may be found by clicking on the Notice of Action link below.
View ICR - OIRA Conclusion
OMB Control No:
0920-0612
ICR Reference No:
201301-0920-004
Status:
Historical Active
Previous ICR Reference No:
201101-0920-002
Agency/Subagency:
HHS/CDC
Agency Tracking No:
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
OIRA Conclusion Action:
Approved without change
Conclusion Date:
01/31/2013
Retrieve Notice of Action (NOA)
Date Received in OIRA:
01/04/2013
Terms of Clearance:
Inventory as of this Action
Requested
Previously Approved
Expiration Date
01/31/2014
12 Months From Approved
03/31/2013
Responses
126
0
126
Time Burden (Hours)
1,680
0
1,680
Cost Burden (Dollars)
0
0
0
Abstract:
CDC requests a one year extension to collect information from WISEWOMAN grantees about activities to be conducted in the final year of the current cooperative agreement. The information collection consists of grantees progress reports and minumum data elements that describe the screening, assessment, and lifestyle intervention services provided to women through the WISEWOMAN program.
Authorizing Statute(s):
PL:
Pub.L. 101 - 354 300n-4a
Name of Law: The Breast and Cervical Cancer Mortality Prevention Act of 1990
US Code:
42 USC 301
Name of Law: Public Health Service Act
Citations for New Statutory Requirements:
None
Associated Rulemaking Information
RIN:
Stage of Rulemaking:
Federal Register Citation:
Date:
Not associated with rulemaking
Federal Register Notices & Comments
60-day Notice:
Federal Register Citation:
Citation Date:
77 FR 62515
10/15/2012
30-day Notice:
Federal Register Citation:
Citation Date:
77 FR 76044
12/26/2012
Did the Agency receive public comments on this ICR?
Yes
Number of Information Collection (IC) in this ICR:
3
IC Title
Form No.
Form Name
Lifestyle Intervention Minimum Data Elements (MDEs)
Progress Report
none
Progress Report
Screening and Assessment Minimum Data Elements (MDEs)
ICR Summary of Burden
Total Approved
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
126
126
0
0
0
0
Annual Time Burden (Hours)
1,680
1,680
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:
Annual Cost to Federal Government:
$356,789
Does this IC contain surveys, censuses, or employ statistical methods?
Yes
Part B of Supporting Statement
Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002?
Yes
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?
Uncollected
Agency Contact:
Tony Richardson 404 639-4965 lmr7@cdc.gov
Common Form ICR:
No
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:
01/04/2013
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