Information Collection Request

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

ICR 202304-0920-005 · OMB 0920-0612 · Received in OIRA

⚠️ Notice: This information collection may be outdated. More recent filings for OMB 0920-0612 can be found here:

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

ICR Details

Status	Received in OIRA
Agency/Subagency	HHS/CDC
OMB Control No	0920-0612
Type of Information Collection	No material or nonsubstantive change to a currently approved collection
Previous ICR Reference No	202208-0920-002
Agency Tracking No	0920-0612-23EG
Date Submitted to OIRA	1969-12-31
Requested Expiration Date	1969-12-31