Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)

[NCCHPHP] Comprehensive Evaluations of the WISEWOMAN Programs, The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program

Documents and Forms

Document Name Document Type
Form 0920-1453 Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c) Form and Instruction
Form 0920-1453 Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c) Form and Instruction
0920-1453 Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_r Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_clean.docx Form and Instruction
0920-1453 Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_r Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_clean.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-1453	Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_rev 2025	Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_clean.docx	N/A	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 2	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2	2
Annual IC Time Burden (Hours)	3	3
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.