National Hypertension Control Initiative

ICR 202403-0990-008

OMB: 0990-0482

Federal Form Document

Forms and Documents

Document Name	Status
Form 1 CHCs Uniti Health Form and Instruction	New
Form 1 CHCs: JumpStart Modules Form and Instruction	New
Form 1 CHCs: Use of Azara/Population Health Tool Form and Instruction	New
Form Module 1 CHW Program Modules Form and Instruction	New
Form 2 CHW Assessment Form and Instruction	New
Form 1 CHW Application Form	New
Form 1 CBOs: Social Needs Platforms Readiness Assessment Form and Instruction	Unchanged
Form 1 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction	Unchanged
Form 1 CBO Qualtrics Survey Form and Instruction	Unchanged
30-day FRN NHCI Submitted 3-15-2024.docx Supplementary Document	2024-03-22
NHCI_ Justification for non material_nonsubstantive change for CHC data collection_Final Clean 01.09.2023 (002).docx Justification for No Material/Nonsubstantive Change	2023-01-19
NHCI TA Group 2 Evaluation Survey.docx Supplementary Document	2022-08-16
HRSA NHCI OMB Memo_Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change	2022-08-16
NHCI_Supporting Statement A_updated_3_28_24.docx Supporting Statement A	2024-04-10
30-day 0990-Hypertension__05022022.pdf Supplementary Document	2022-05-03
NHCI 60d FRN 2021-19975.pdf Supplementary Document	2022-04-15
Appendix F_CHC Readiness Assessment.pdf Supplementary Document	2022-04-15
Appendix E_CBO Readiness Assessment.pdf Supplementary Document	2022-04-15
Appendix D2_ETS Salt and Cardiovascular Risk.pdf Supplementary Document	2022-04-15
Appendix D2_ETS Salt and Cardiovascular Risk.pdf Supplementary Document	2022-04-15
Appendix D1_ETS Control Your Blood Pressure.pdf Supplementary Document	2022-04-15
Appendix C_Feasibility Assessments-CHCs and CBOs_Final.docx Supplementary Document	2022-04-15
Appendix B_Qualtrics and DREaM CBO quarterly survey questions_Final.docx Supplementary Document	2022-04-15
Appendix A_Qualtrics and DREaM CHC quarterly survey questions_Final.docx Supplementary Document	2022-04-15
NHCI_Supporting Statement B Statistical Methods_Final.docx Supporting Statement B	2022-04-15

IC Document Collections

IC ID	Document Title	Status
266250	CHCs Uniti Health Form and Instruction	New
266249	CHCs: JumpStart Modules Form and Instruction	New
266248	CHCs: Use of Azara/Population Health Tool Form and Instruction	New
266245	CHW Program Modules Form and Instruction	New
266244	CHW Assessment Form and Instruction	New
266239	CHW Application Form	New
252928	Blood Pressure Control Metrics via Electronic Health Records	Unchanged
252927	Individual Consumers: Remote Patient Monitoring (RPM)	Unchanged
252926	CBOs: Remote Patient Monitoring (RPM)	Unchanged
252925	Management Occupation: Remote Patient Monitoring Provider data delivery	Unchanged
252924	Individual Consumers: Social Needs Platform Participation	Unchanged
252923	CBOs: Social Needs Platforms Readiness Assessment Form and Instruction	Unchanged
252922	CHCs: Social Needs Platforms Readiness Assessment	Unchanged
252921	Individual Consumers: ETS health lesson learning questionnaires Form and Instruction	Unchanged
252920	CBOs: Feasibility assessment focus groups Other-Interview Questions	Unchanged
252919	CHCs: Feasibility assessment focus groups Other-Interview Questions	Unchanged
252918	CBOs: Training on data entry into DREaM	Unchanged
252917	CHCs: Training on data entry into DREaM	Unchanged
252916	CBO Qualtrics Survey Form and Instruction	Unchanged
252914	CHC Qualtrics Survey Other-instruction and form	Unchanged