Assessment of Women’s Behavioral Health in Eastern Montana and Western North Dakota

Forms and Documents

Document Name	Status
OWH_Survey_012518.pdf Supplementary Document	2018-02-13
60-day Federal Register, Volume 81 Issue 190 (Friday, September 30, 2016).htm Supplementary Document	2017-08-29
30-day Federal Register, Volume 82 Issue 165 (Monday, August 28, 2017).htm Supplementary Document	2017-08-29
OWH_OMB stipend receipt form template_081517.doc Supplementary Document	2017-08-22
NEIRB approval letter.PDF Supplementary Document	2017-08-22
FtPeckIRB Approval Letter.pdf Supplementary Document	2017-08-22
OWH_OMB SSB_Revised 021218.docx Supporting Statement B	2018-02-13
OWH_OMB SSA_Revised 021218.docx Supporting Statement A	2018-02-13

IC Document Collections

IC ID	Document Title	Status
227988	Interviews Other-guide interview	New
227987	Focus Groups Other-survey	New
227986	Community Survey Other-survey	New

ICR Details

OMB Control No: 0990-0462	ICR Reference No: 201612-0990-003
Status: Active	Previous ICR Reference No:
Agency/Subagency: HHS/HHSDM	Agency Tracking No:
Title: Assessment of Women’s Behavioral Health in Eastern Montana and Western North Dakota
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 02/13/2018
	Date Received in OIRA: 08/30/2017
Terms of Clearance: Approved with the understanding that the limitations of the study will be made clear when and if they are published, and the study will not be described as an evaluation of the impact of energy development on the local population.

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2021	36 Months From Approved
Responses	780	0	0
Time Burden (Hours)	525	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: The goal or mission is to provide national leadership and coordination to improve the health of women and girls through policy, education and model programs. The vision of the Office on Women's Health is that all women and girls achieve the best possible health. OASH/OWH has ten regional offices located throughout the country. As a leader in women health, OWH supports the development of culturally-based, gender-sensitive programs to address health disparities. Region VIII OASH/OWH is interested in improving women's behavioral health associated with the impact of energy development through gender based data collection and analysis.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Section 301 of the 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:
	81 FR 67363	09/30/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	82 FR 40774	08/28/2017
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Focus Groups
Community Survey
Interviews

---

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	780	0	0	780	0	0
Annual Time Burden (Hours)	525	0	0	525	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: New collection

---

Annual Cost to Federal Government: $71,615

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

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

---

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: 08/30/2017

---