Information Collection

Community Health Worker Certification: Effective Strategies and Potential Challenges

IC 225575 under ICR 201412-0920-011 · OMB 0920-0879.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.