Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Blood Pressure Control Metrics via Electronic Health Records New 350 0 0
CBO Qualtrics Survey New 128 192 0 Form and Instruction 1 CBOs: Qualtrics survey
CBOs: Feasibility assessment focus groups New 96 72 0 Other-Interview Questions
CBOs: Remote Patient Monitoring (RPM) New 5 5 0
CBOs: Social Needs Platforms Readiness Assessment New 4 4 0 Form and Instruction 1 CHCs: Social Needs Platforms Readiness Assessment
CBOs: Training on data entry into DREaM New 16 16 0
CHC Qualtrics Survey New 2800 1050 0 Other-instruction and form
CHCs: Feasibility assessment focus groups New 96 72 0 Other-Interview Questions
CHCs: Social Needs Platforms Readiness Assessment New 350 88 0
CHCs: Training on data entry into DREaM New 350 350 0
Individual Consumers: ETS health lesson learning questionnaires New 3120 1872 0 Form and Instruction 1 ETS Control Your Blood Pressure
Form and Instruction 2 Salt and Cardiovascular Risk
Form and Instruction 3 ET Get Active
Individual Consumers: Remote Patient Monitoring (RPM) New 2750 2750 0
Individual Consumers: Social Needs Platform Participation New 10000 1666 0
Management Occupation: Remote Patient Monitoring Provider data delivery New 4 4 0
Total burden requested under this ICR: 20069 8141 0  
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