Information Collection Request

National Hypertension Control Initiative

ICR 202204-0990-005 · OMB 0990-0482 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 CHCs: Social Needs Platforms Readiness Assessment Form and Instruction New Available
Form 1 CBOs: Social Needs Platforms Readiness Assessment Form and Instruction New Repair queued
Form 3 ET Get Active Form and Instruction New Available
Form 2 Salt and Cardiovascular Risk Form and Instruction New Available
Form 1 ETS Control Your Blood Pressure Form and Instruction New Repair queued
Form 1 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction New Repair queued
Form 1 CBOs: Qualtrics survey Form and Instruction New Available
Form 1 CBO Qualtrics Survey Form and Instruction New Repair queued
NHCI_Supporting Statement A_Final (4).docx Supporting Statement A Uploaded 2022-05-10 Repair queued
30-day 0990-Hypertension__05022022.pdf Supplementary Document Uploaded 2022-05-03 Repair queued
NHCI 60d FRN 2021-19975.pdf Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix F_CHC Readiness Assessment.pdf Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix E_CBO Readiness Assessment.pdf Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix D2_ETS Salt and Cardiovascular Risk.pdf Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix D2_ETS Salt and Cardiovascular Risk.pdf Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix D1_ETS Control Your Blood Pressure.pdf Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix C_Feasibility Assessments-CHCs and CBOs_Final.docx Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix B_Qualtrics and DREaM CBO quarterly survey questions_Final.docx Supplementary Document Uploaded 2022-04-15 Repair queued
Appendix A_Qualtrics and DREaM CHC quarterly survey questions_Final.docx Supplementary Document Uploaded 2022-04-15 Repair queued
NHCI_Supporting Statement B Statistical Methods_Final.docx Supporting Statement B Uploaded 2022-04-15 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
252928 Blood Pressure Control Metrics via Electronic Health Records New
252927 Individual Consumers: Remote Patient Monitoring (RPM) New
252926 CBOs: Remote Patient Monitoring (RPM) New
252925 Management Occupation: Remote Patient Monitoring Provider data delivery New
252924 Individual Consumers: Social Needs Platform Participation New
252923 CBOs: Social Needs Platforms Readiness Assessment Form and Instruction NewCHCs: Social Needs Platforms Readiness Assessment
252923 CBOs: Social Needs Platforms Readiness Assessment Form and Instruction New
252922 CHCs: Social Needs Platforms Readiness Assessment New
252921 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction NewET Get Active
252921 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction NewSalt and Cardiovascular Risk
252921 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction NewETS Control Your Blood Pressure
252921 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction New
252920 CBOs: Feasibility assessment focus groups Other-Interview Questions New
252919 CHCs: Feasibility assessment focus groups Other-Interview Questions New
252918 CBOs: Training on data entry into DREaM New
252917 CHCs: Training on data entry into DREaM New
252916 CBO Qualtrics Survey Form and Instruction NewCBOs: Qualtrics survey
252916 CBO Qualtrics Survey Form and Instruction New
252914 CHC Qualtrics Survey Other-instruction and form New

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
06/30/2025 36 Months From Approved
20,069 0 0
8,141 0 0
0 0 0





table that charts list of burden
  Total Approved Previously Approved Change Due to New Statute Change Due to Agency Discretion Change Due to Adjustment in Estimate Change Due to Potential Violation of the PRA
Annual Number of Responses 20,069 0 0 20,069 0 0
Annual Time Burden (Hours) 8,141 0 0 8,141 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No