Information Collection Request

National Hypertension Control Initiative

ICR 202403-0990-008 · OMB 0990-0482 · Historical Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 1 CHCs Uniti Health Form and Instruction New Repair queued
Form 1 CHCs: JumpStart Modules Form and Instruction New Repair queued
Form 1 CHCs: Use of Azara/Population Health Tool Form and Instruction New Repair queued
Form Module 1 CHW Program Modules Form and Instruction New Repair queued
Form 2 CHW Assessment Form and Instruction New Repair queued
Form 1 CHW Application Form New Missing upstream
Form 1 CBOs: Social Needs Platforms Readiness Assessment Form and Instruction Unchanged Repair queued
Form 1 Individual Consumers: ETS health lesson learning questionnaires Form and Instruction Unchanged Repair queued
Form 1 CBO Qualtrics Survey Form and Instruction Unchanged Repair queued
30-day FRN NHCI Submitted 3-15-2024.docx Supplementary Document Uploaded 2024-03-22 Repair queued
NHCI_ Justification for non material_nonsubstantive change for CHC data collection_Final Clean 01.09.2023 (002).docx Justification for No Material/Nonsubstantive Change Uploaded 2023-01-19 Repair queued
NHCI TA Group 2 Evaluation Survey.docx Supplementary Document Uploaded 2022-08-16 Repair queued
HRSA NHCI OMB Memo_Non-Substantive Change.docx Justification for No Material/Nonsubstantive Change Uploaded 2022-08-16 Repair queued
NHCI_Supporting Statement A_updated_3_28_24.docx Supporting Statement A Uploaded 2024-04-10 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 Available
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 Available
Appendix B_Qualtrics and DREaM CBO quarterly survey questions_Final.docx Supplementary Document Uploaded 2022-04-15 Available
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
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

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
07/31/2025 36 Months From Approved 06/30/2025
25,609 0 20,069
10,031 0 8,141
23,990 0 0





Reginfo record details
20
table that charts list of burden
IC Title Form No. Form Name
Blood Pressure Control Metrics via Electronic Health Records
CBO Qualtrics Survey 1
CBOs: Feasibility assessment focus groups
CBOs: Remote Patient Monitoring (RPM)
CBOs: Social Needs Platforms Readiness Assessment 1
CBOs: Training on data entry into DREaM
CHC Qualtrics Survey
CHCs Uniti Health 1
CHCs: Feasibility assessment focus groups
CHCs: JumpStart Modules 1
CHCs: Social Needs Platforms Readiness Assessment
CHCs: Training on data entry into DREaM
CHCs: Use of Azara/Population Health Tool 1
CHW Application 1
CHW Assessment 2
CHW Program Modules Module 1, Module 2, Module 3, Module 4, Module 5, Module 6, Module 7 ,   ,   ,   ,   ,   ,  
Individual Consumers: ETS health lesson learning questionnaires 1, 2, 3 ,   ,  
Individual Consumers: Remote Patient Monitoring (RPM)
Individual Consumers: Social Needs Platform Participation
Management Occupation: Remote Patient Monitoring Provider data delivery

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 25,609 20,069 0 5,540 0 0
Annual Time Burden (Hours) 10,031 8,141 0 1,890 0 0
Annual Cost Burden (Dollars) 23,990 0 0 23,990 0 0


Reginfo record details
  No