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pdfIHS OSCAR System - Step 1 - Best and Promising Practice and Local Effort Electronic Submission Form
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Step 1 - Best and Promising Practice and Local Effort Electronic Submission Form
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To submit a best practice, promising practice, local effort, resource, or policy, please complete the
inventory form below. Your submission will not be saved until the final step and you will be prompted
to complete all required fields. At the end of the form, you will have an opportunity to preview and edit
your submission before sending it to the database.
OMB Approval No. 0917-0034
Exp. Date 11/30/2011
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* 1. Please provide the name, title and contact information for the person filling in this template.
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By submitting this form you are agreeing that you or your designee can be contacted regarding this submission.
Public Burden Statement: In accordance with Paperwork Reduction Act (5 CFR 1320.8 (b)(3), a Federal agency may not conduct or sponsor,
and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Respondents
must be informed (on the reporting instrument, in instructions, or in a cover letter) the reasons for which the information will be collected; the
way the information will be used to further the proper performance of the functions of the agency; whether responses to the collection of the
information are voluntary, required to obtain a benefit (citing authority), or mandatory (citing authority); and the nature and extent of
confidentiality to be provided, if any (citing authority). Public reporting burden for this collection of information is estimated to average 20
minutes per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the necessary
data, and completing and reviewing the collection information. Send comments regarding the burden estimate or any other aspect of this
collection of information to the IHS PRA Information Collection Clearance Staff, 801 Thompson Ave., Suite 450, Rockville, MD 20852.
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Step 3 - Best and Promising Practice and Local Effort Electronic Submission Form
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*4. Please choose the service area, from the drop down list below, that best describes the location of the
program or information you are submitting. A map of the 12 IHS service areas is below to help you with
your selection.
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* 5. What is the Title of the program or information being entered?
* 6. Please define the project's target population: (check all that apply)
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Infants (0-12 months)
Toddler (12-24 months)
Children (2-11 years)
Adults (18-64 years)
Adolescent (12-17 years)
Elderly (65+ years)
* 7. Please describe the type of location where the project takes place: (check all that apply)
Community
Hospital
School
Clinic/Health Center
Home
Work site
Other (please specify)
* 8. Please check the targeted health indicators impacted by the project. (Check all that Apply)
Note: Review of content is based partially on the Health Indicator(s) selected. Selecting more than one Indicator
might require additional review, result in delay of approval, and publication of your submission for one Indicator
before others.
Cardiovascular Disease
Healthcare Access
Oral Health
Child Abuse/Neglect
Immunization
Overweight and Obesity
Diabetes
Infectious Disease
Pets/Animals
Domestic Violence
Information Technology
Physical Activity
Environmental Quality
Injury and Violence
Substance Abuse
Excessive Alcohol Consumption
Maternal Child Health
Tobacco Use
Health Education
Mental Health
Traditional Healing
Methamphetamines
9. Please describe the project that you are submitting.
10. Please list the website where information about the program can be found (if applicable):
11. Please select at least one key word that would describe the project you are submitting. (Check all
that apply)
Advocacy
Lifestyle coaching
Alcohol/substance abuse prevention
Motivation
Asthma
Nutrition
Behavioral health/behavioral change
Physical activity
Breastfeeding
Pregnancy prevention
Capacity building or empowerment
Public Health intervention
Child abuse prevention
School health
Chronic conditions
Scientific research
Community assessment
Staff qualification or credentials
Community directed intervention
Sudden Infant Death Syndrome
Community mobilization/organization
Suicide prevention
Disability
Surveillance
Disability prevention
Teaching strategies
Domestic violence prevention
Tobacco cessation
Drug abuse prevention
Traumatic Brain Injury
Environmental change
Unintentional injury
Group process
Violence and Intentional injury
Health literacy
Worksite health
Health promotion and wellness
Zoonotic Disease (has an animal link)
HIV prevention
Other(please specify)
Interview and teaching strategies
Questions 12 to 13 are required in order to be considered evidence based practice or submission will be considered a promising
practice or local effort upon evaluation unless materials are available for review.
* 12. Was the project evaluated?
Yes
No
* 13. Is the evaluation summary available?
Yes
No
* 14. Please specify a file or a set of files:
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Accepted file types are: .doc, .pdf, .txt, .rtf
* If you are not able to upload your documents, or your documents are larger than 5 MB in size, you may send the evaluation materials
one of the following ways:
Mail Address:
Indian Health Service
Attn: OSCAR Team
801 Thompson Ave, Suite 300
Rockville,MD 20852
Fax: (301)594-6213, or (301) 443-7623
Attn: OSCAR Team
15. What is/was the overall cost (estimate) of the program?
N/A
16. Any final comments?
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Accessibility · Disclaimer · Website Privacy Policy · Freedom of Information Act · Kid's Page · Contact
Indian Health Service (HQ) - The Reyes Building, 801 Thompson Avenue, Ste. 400 - Rockville, MD 20852
| File Type | application/pdf |
| File Title | IHS OSCAR System - Step 1 - Best and Promising Practice and Local Effort Electronic Submission Form |
| File Modified | 2009-11-10 |
| File Created | 2009-11-10 |