Information Collection

National Hypertension Control Initiative (NHCI) Community Health Center Assessment

IC 263257 under ICR 202307-0990-003 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 National Hypertension Control Initiative (NHCI) Community Health Center Assessment	Form and Instruction
1 National Hypertension Control Initiative (NHCI) Communit 0990-0379 BPHC card sort test script.docx	Form and Instruction
0990-0379 NHCI Health Center Assessment Memo-correct.docx Fast Track Memo	IC Document

IC Title:

National Hypertension Control Initiative (NHCI) Community Health Center Assessment

Agency IC Tracking Number:

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	1	National Hypertension Control Initiative (NHCI) Community Health Center Assessment	0990-0379 BPHC card sort test script.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 350

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	350	350
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Memo	0990-0379 NHCI Health Center Assessment Memo-correct.docx	11/07/2023

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