Community Health Worker Certification: Effective Strategies and Potential Challenges

Information Collections to Advance State, Tribal, Local and Territorial (STLT) Governmental Agency System Performance, Capacity, and Program Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0879 can be found here:

Documents and Forms

Document Name Document Type
Community Health Worker Certification: Effective Strategies and Potential Challenges Form and Instruction
Telephone Interview Guide Attachment A_Telephone Interview Guide.docx Form and Instruction
CHW-CASE-SSA.docx Supporting Statement Part A IC Document
CHW-CASE-SSB.docx Supporting Statement Part B IC Document
Attachment B_Recruitment Email.docx Recruitment Email IC Document
Attachment C_Email Reminder.docx Email Reminder IC Document
Attachment D_Telephone Reminder.docx Telephone Reminder IC Document
Attachment E_Confirmation Email.docx Confirmation Email IC Document
Attachment F_Follow-up Email.docx Follow-up Email IC Document

Information Collection (IC) Details

IC Title:	Community Health Worker Certification: Effective Strategies and Potential Challenges	Agency IC Tracking Number:	0920-17QW CHW-CASE

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	N/A	Telephone Interview Guide	Attachment A_Telephone Interview Guide.docx		No		Paper Only

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 49	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	49	49
Annual IC Time Burden (Hours)	74	74
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Supporting Statement Part A	CHW-CASE-SSA.docx	02/22/2017
Supporting Statement Part B	CHW-CASE-SSB.docx	02/22/2017
Recruitment Email	Attachment B_Recruitment Email.docx	02/22/2017
Email Reminder	Attachment C_Email Reminder.docx	02/22/2017
Telephone Reminder	Attachment D_Telephone Reminder.docx	02/22/2017
Confirmation Email	Attachment E_Confirmation Email.docx	02/22/2017
Follow-up Email	Attachment F_Follow-up Email.docx	02/22/2017

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.