CBOs: Social Needs Platforms Readiness Assessment

National Hypertension Control Initiative

Documents and Forms

Document Name Document Type
Form 1 CBOs: Social Needs Platforms Readiness Assessment Form and Instruction
1 CHCs: Social Needs Platforms Readiness Assessment Appendix F_CHC Readiness Assessment.pdf Form and Instruction
1 CHCs: Social Needs Platforms Readiness Assessment Appendix F_CHC Readiness Assessment.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	CBOs: Social Needs Platforms Readiness Assessment	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation: 5 CFR CFR 1320.8(d) (To search for a specific CFR, visit the Code of Federal Regulations.)

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	CHCs: Social Needs Platforms Readiness Assessment	Appendix F_CHC Readiness Assessment.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title: CBOs: Social Needs Platforms Readiness Assessment	FR Citation: 86 FR 70510

Number of Respondents: 4	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	4	4
Annual IC Time Burden (Hours)	4	4
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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