Information Collection List

IC Title Status Responses Hours Dollars Document Type Form No. Form Name
Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b) New 55 138 0 Form and Instruction 0920-24FI Cost Study – Partner Interview Guide
Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a) New 37 93 0 Form and Instruction 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool (Recipient)
Cost Study Interview Guide_Partner (Attachment 5d) New 55 55 0 Form and Instruction 0920-24FI Cost Study – Partner Interview Guide
Cost Study Interview Guide_Recipient (Attachment 5c) New 37 37 0 Form and Instruction 0920-24FI Cost Study – Recipient Interview Guide
Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n) New 6 9 0 Form and Instruction 0920-24FI Evaluability Assessment Partner Interview Guide
Eval Assessment CCL Partner Interview Guide WW (Attachment 3o) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN
Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f) New 6 9 0 Form and Instruction 0920-24FI Evaluability Assessment Partner Interview Guide
Eval Assessment CQM Partner Interview Guide WW (Attachment 3g) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d) New 6 9 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c) New 12 12 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j) New 6 9 0 Form and Instruction 0920-24FI Evaluability Assessment Partner Interview Guide
Eval Assessment TBC Partner Interview Guide WW (Attachment 3k) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h) New 6 9 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN
Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a) New 24 12 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Nomination Form – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Evaluability Assessment Nomination Form_WW (Attachment 3b) New 12 6 0 Form and Instruction 0920-24FI In-Depth Assessment – Evaluability Assessment Nomination Form – WISEWOMAN
Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m) New 1 2 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – WISEWOMAN
Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k) New 2 3 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN
Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e) New 1 2 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – WISEWOMAN
Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c) New 2 3 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a) New 6 6 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i) New 1 2 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – WISEWOMAN
Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f) New 3 5 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g) New 2 3 0 Form and Instruction 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN
Total burden requested under this ICR: 316 484 0  
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