[NCCHPHP] Comprehensive Evaluations of theDP-23-003, DP-23-004, and DP-23-0005 Cooperative Agreement Programs: The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c)	Form and Instruction	New	Repair queued
Form 0920-24FI Cost Study – Partner Interview Guide	Form and Instruction	New	Available
Form 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b)	Form and Instruction	New	Repair queued
Form 0920-24FI Cost Study – Partner Interview Guide	Form and Instruction	New	Available
Form 0920-24FI Cost Study Interview Guide_Partner (Attachment 5d)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CCL Partner Interview Guide WW (Attachment 3o)	Form and Instruction	New	Repair queued
Form 0920-24FI Evaluability Assessment Partner Interview Guide	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment TBC Partner Interview Guide WW (Attachment 3k)	Form and Instruction	New	Repair queued
Form 0920-24FI Evaluability Assessment Partner Interview Guide	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CQM Partner Interview Guide WW (Attachment 3g)	Form and Instruction	New	Repair queued
Form 0920-24FI Evaluability Assessment Partner Interview Guide	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f)	Form and Instruction	New	Repair queued
Form 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool (Recipient)	Form and Instruction	New	Available
Form 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)	Form and Instruction	New	Available
Form 0920-24FI Cost Study – Recipient Interview Guide	Form and Instruction	New	Available
Form 0920-24FI Cost Study Interview Guide_Recipient (Attachment 5c)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)	Form and Instruction	New	Available
Form 0920-24FI In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Nomination Form – WISEWOMAN	Form and Instruction	New	Available
Form 0920-24FI Evaluability Assessment Nomination Form_WW (Attachment 3b)	Form and Instruction	New	Repair queued
Form 0920-24FI In-Depth Assessment – Evaluability Assessment Nomination Form – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program	Form and Instruction	New	Available
Form 0920-24FI Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)	Form and Instruction	New	Repair queued
Supporting Statement B.docx	Supporting Statement B	Uploaded 2024-11-01	Available
Supporting Statement B.docx	Supporting Statement B	Uploaded 2024-11-01	Repair queued
Supporting Statement A.docx	Supporting Statement A	Uploaded 2024-11-08	Repair queued
Supporting Statement A.docx	Supporting Statement A	Uploaded 2024-11-08	Repair queued
Att 2c. 42 USC Section 241a.docx	Supplementary Document	Uploaded 2024-11-01	Available
Att 2c. 42 USC Section 241a.docx	Supplementary Document	Uploaded 2024-11-01	Repair queued
Att 2f. FY 2023 Consolidated Appropriations Act.pdf	Supplementary Document	Uploaded 2024-10-31	Available
Att 2f. FY 2023 Consolidated Appropriations Act.pdf	Supplementary Document	Uploaded 2024-10-31	Repair queued
Att 2e. 42 USC 300I.docx	Supplementary Document	Uploaded 2024-10-31	Available
Att 2e. 42 USC 300I.docx	Supplementary Document	Uploaded 2024-10-31	Repair queued
Att 2d. 42 USC 300n-4a.docx	Supplementary Document	Uploaded 2024-10-31	Available
Att 2d. 42 USC 300n-4a.docx	Supplementary Document	Uploaded 2024-10-31	Repair queued
Att 2b. 42 USC 300u-11.pdf	Supplementary Document	Uploaded 2024-10-31	Available
Att 2b. 42 USC 300u-11.pdf	Supplementary Document	Uploaded 2024-10-31	Repair queued
Att 2a. 42 USC 247b.pdf	Supplementary Document	Uploaded 2024-10-31	Available
Att 2a. 42 USC 247b.pdf	Supplementary Document	Uploaded 2024-10-31	Repair queued
Att 1c. CDC-RFA-DP-23-0003_Revised_Wisewoman.pdf	Supplementary Document	Uploaded 2024-10-08	Available
Att 1c. CDC-RFA-DP-23-0003_Revised_Wisewoman.pdf	Supplementary Document	Uploaded 2024-10-08	Repair queued
Att 1b. CDC-RFA-DP-23-0005_Innovative.pdf	Supplementary Document	Uploaded 2024-10-08	Available
Att 1b. CDC-RFA-DP-23-0005_Innovative.pdf	Supplementary Document	Uploaded 2024-10-08	Repair queued
Att 1a. CDC-RFA-DP-23-0004_National.pdf	Supplementary Document	Uploaded 2024-10-08	Available
Att 1a. CDC-RFA-DP-23-0004_National.pdf	Supplementary Document	Uploaded 2024-10-08	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
272080	Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
272080	Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a)	Form and Instruction	New
272079	Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
272079	Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c)	Form and Instruction	New
272078	Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b)	Form and Instruction	New	Cost Study – Partner Interview Guide
272078	Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b)	Form and Instruction	New
272076	Cost Study Interview Guide_Partner (Attachment 5d)	Form and Instruction	New	Cost Study – Partner Interview Guide
272076	Cost Study Interview Guide_Partner (Attachment 5d)	Form and Instruction	New
272075	Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – WISEWOMAN
272075	Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m)	Form and Instruction	New
272074	Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
272074	Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l)	Form and Instruction	New
272073	Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – WISEWOMAN
272073	Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i)	Form and Instruction	New
272071	Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
272071	Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h)	Form and Instruction	New
272070	Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – WISEWOMAN
272070	Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e)	Form and Instruction	New
272069	Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
272069	Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d)	Form and Instruction	New
272067	Eval Assessment CCL Partner Interview Guide WW (Attachment 3o)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
272067	Eval Assessment CCL Partner Interview Guide WW (Attachment 3o)	Form and Instruction	New
272066	Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n)	Form and Instruction	New	Evaluability Assessment Partner Interview Guide
272066	Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n)	Form and Instruction	New
272064	Eval Assessment TBC Partner Interview Guide WW (Attachment 3k)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
272064	Eval Assessment TBC Partner Interview Guide WW (Attachment 3k)	Form and Instruction	New
272063	Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j)	Form and Instruction	New	Evaluability Assessment Partner Interview Guide
272063	Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j)	Form and Instruction	New
272061	Eval Assessment CQM Partner Interview Guide WW (Attachment 3g)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
272061	Eval Assessment CQM Partner Interview Guide WW (Attachment 3g)	Form and Instruction	New
272059	Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f)	Form and Instruction	New	Evaluability Assessment Partner Interview Guide
272059	Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f)	Form and Instruction	New
272058	Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)	Form and Instruction	New	Comprehensive Evaluation Resource Use and Cost Inventory Tool (Recipient)
272058	Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)	Form and Instruction	New
272038	Cost Study Interview Guide_Recipient (Attachment 5c)	Form and Instruction	New	Cost Study – Recipient Interview Guide
272038	Cost Study Interview Guide_Recipient (Attachment 5c)	Form and Instruction	New
271848	Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN
271848	Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)	Form and Instruction	New
271847	Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271847	Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j)	Form and Instruction	New
271846	Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN
271846	Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g)	Form and Instruction	New
271845	Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271845	Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f)	Form and Instruction	New
271844	Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
271844	Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)	Form and Instruction	New
271843	Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b)	Form and Instruction	New	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271843	Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b)	Form and Instruction	New
271842	Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN
271842	Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m)	Form and Instruction	New
271841	Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271841	Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l)	Form and Instruction	New
271840	Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN
271840	Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i)	Form and Instruction	New
271839	Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271839	Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h)	Form and Instruction	New
271838	Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
271838	Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e)	Form and Instruction	New
271497	Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271497	Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d)	Form and Instruction	New
271477	Evaluability Assessment Nomination Form_WW (Attachment 3b)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Nomination Form – WISEWOMAN
271477	Evaluability Assessment Nomination Form_WW (Attachment 3b)	Form and Instruction	New
271476	Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)	Form and Instruction	New	In-Depth Assessment – Evaluability Assessment Nomination Form – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
271476	Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)	Form and Instruction	New

ICR Details

OMB Control No: 0920-1453	ICR Reference No: 202410-0920-005
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-24FI
Title: [NCCHPHP] Comprehensive Evaluations of theDP-23-003, DP-23-004, and DP-23-0005 Cooperative Agreement Programs: The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/16/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 11/08/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	36 Months From Approved
Responses	316	0	0
Time Burden (Hours)	484	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the project is to conduct a comprehensive implementation and outcome evaluation to assess the unique contributions of The National Cardiovascular Health Program (The National CVH Program), The Innovative Cardiovascular Health Program (The Innovative CVH Program), and Well-Integrated Screening and Evaluation of Women Across the Nation (WISEWOMAN) cooperative agreements to identify promising cardiovascular disease (CVD) prevention and management practices that can be scaled and replicated, advance health equity, and the transformation of health systems for improved CVD prevention and management. The programs work together to create efficiencies and improve outcomes in jurisdictions that receive funding for two or more of the cooperative agreements. This evaluation aims to describe program implementation, assess the extent to which short-term, intermediate, and long-term outcomes have been met, and estimate the costs involved in program implementation.

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Authorizing Statute(s): PL: Pub.L. 117 - 328 136 STAT. 4459 Name of Law: An Act
   US Code: 42 USC 247b Name of Law: Project grants for Preventive Health Services
   US Code: 42 USC Title IV, Sec. 4002, 300u-11 Name of Law: Affordable Care Ac, Prevention and Helath Fund
   US Code: 42 USC Title XV, Sec. 1509 Name of Law: Public Health Service Act
   US Code: 42 USC Sec. 1502, 3001 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 38151	05/07/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 88778	11/08/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 32

table that charts list of burden

IC Title	Form No.	Form Name
Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b)	0920-24FI	Cost Study – Partner Interview Guide
Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)	0920-24FI	Comprehensive Evaluation Resource Use and Cost Inventory Tool (Recipient)
Cost Study Interview Guide_Partner (Attachment 5d)	0920-24FI	Cost Study – Partner Interview Guide
Cost Study Interview Guide_Recipient (Attachment 5c)	0920-24FI	Cost Study – Recipient Interview Guide
Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n)	0920-24FI	Evaluability Assessment Partner Interview Guide
Eval Assessment CCL Partner Interview Guide WW (Attachment 3o)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN
Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f)	0920-24FI	Evaluability Assessment Partner Interview Guide
Eval Assessment CQM Partner Interview Guide WW (Attachment 3g)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d)	0920-24FI	In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c)	0920-24FI	In-Depth Assessment – Evaluability Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j)	0920-24FI	Evaluability Assessment Partner Interview Guide
Eval Assessment TBC Partner Interview Guide WW (Attachment 3k)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i)	0920-24FI	In-Depth Assessment – Evaluability Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN
Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)	0920-24FI	In-Depth Assessment – Evaluability Assessment Nomination Form – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Evaluability Assessment Nomination Form_WW (Attachment 3b)	0920-24FI	In-Depth Assessment – Evaluability Assessment Nomination Form – WISEWOMAN
Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l)	0920-24FI	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m)	0920-24FI	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Community Clinical Links – WISEWOMAN
Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j)	0920-24FI	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)	0920-24FI	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Community Clinical Links – WISEWOMAN
Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d)	0920-24FI	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e)	0920-24FI	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Clinical Quality Measure – WISEWOMAN
Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b)	0920-24FI	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)	0920-24FI	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Clinical Quality Measure – WISEWOMAN
Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a)	0920-24FI	In-Depth Assessment – Exploratory Assessment Learning Collaborative Interview Guide – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h)	0920-24FI	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i)	0920-24FI	In-Depth Assessment – Exploratory Assessment Partner Interview Guide – Team-Based Care – WISEWOMAN
Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f)	0920-24FI	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – The National Cardiovascular Health Program & The Innovative Cardiovascular Health Program
Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g)	0920-24FI	In-Depth Assessment – Exploratory Assessment Recipient Interview Guide – Team-Based Care – WISEWOMAN

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ICR Summary of Burden

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	316	0	0	316	0	0
Annual Time Burden (Hours)	484	0	0	484	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new request for information collection.

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Annual Cost to Federal Government: $708,783

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/08/2024

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