Summary of Respondents and Conversion for Annualization

Attachment 3f: Crosswalk of Type and Number of Respondents (total and annualized), by Evaluation Component and Information Collection Instrument

DP18-1815PHHF18

Improving the Health of Americans through Prevention and Management of Diabetes and Heart Disease and Stroke

Category B: CARDIOVASCULAR DISEASE PREVENTION AND MANAGEMENT

This cell = 1 if the form will be completed 1 time during the 3-year clearance period

This cell = 2 if the form will be completed 2 times during the 3-year clearance period

This cell = 3 if the form will be completed 3 times (i.e., annually) during the 3-year clearance period

No. sampled x Total Times / 3 = This cell

Type of Respondents (and Sampling Frame)	Form Name	No. in Respondent Universe	Total No. to be sampled	Total No. of Times the Form will be Completed over the 3-year clearance period	Annualized Number of Respondents
Category B Case Study – Site-Level Interview Guides
Partner site staff (Physicians, Pharmacists, Nurses, and Medical and Health Services Manager)	CQM Partner Site-Level Interview Guide	Unknown	45	1	15
Partner site staff (Physicians, Pharmacists, Nurses, and CHWs)	TBC Partner Site-Level Interview Guide1	Unknown	24	1	8
Partner site staff (Physicians, Pharmacists)	MTM Partner Site-Level Interview Guide1	Unknown	21	1	7
Partner site staff (Physicians, Nurses, and CHWs)	CCL Partner Site-Level Interview Guide	Unknown	45	1	15
Category B Case Study – HD-Level Interview Guides
HD recipient staff (HD Recipient Staff)	CQM HD Recipient Interview Guide	Unknown	25	2	17
	TBC HD Recipient Interview Guide1	Unknown	13	2	9
	MTM HD Recipient Interview Guide1	Unknown	12	2	8
	CCL HD Recipient Interview Guide	Unknown	25	2	17
Category B Case Study – HD-Level Discussion Guide
HD recipient staff (HD Recipient Staff)	CQM HD Recipient Group Discussion Guide	Unknown	40	2	27
	TBC HD Recipient Group Discussion Guide	Unknown	40	2	27
	CCL HD Recipient Group Discussion Guide	Unknown	40	2	27
Category B Cost Study
HD recipient staff (HD Recipient Staff)	HD Recipient Resource Use and Cost Inventory Tool (Category B)	51	25	1	8
Partner site staff (Partner Site Staff)	Partner Site-Level Resource Use and Cost Inventory Tool (Category B)	Unknown	50	1	17
1815 Recipient-Led Evaluation Reporting Deliverables
HD recipient staff (HD Recipient Staff)	Category B - DHDSP Recipient-led Evaluation Reporting Deliverable Template(s)	51	51	3	51
Total
			446 respondents to be sampled		253 annualized number of respondents

1 TBC and MTM interviews will both be used to inform the same TBC Case Studies. Since this program area requires two distinct interview guides, the total estimated number of participants has been split across the two guides.

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