Information Collection Request

[NCCDPHP] Million Hearts® Hospital/Health System Recognition Program

ICR 202507-0920-019 · OMB 0920-1274 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-1274 Communications Interview Guide Form Modified Available
Form 0920-1274 Interview Guide Form Modified Repair queued
Form 0920-1274 Data Collection Application Form Modified Available
Form 0920-1274 Program Application Form Modified Available
Attachment 9. Privacy Impact Assessment Form_0920-1274_signed.pdf Supplementary Document Uploaded 2025-08-05 Available
Attachment 9. Privacy Impact Assessment Form_0920-1274_signed.pdf Supplementary Document Uploaded 2025-08-05 Repair queued
Attachment 3b. Public Comment to 60 Day FRN and Response.docx Public Comments Uploaded 2025-08-05 Available
Attachment 7. Program Communications_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 7. Program Communications_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Repair queued
Attachment 6. Approach to Designee Vetting_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 6. Approach to Designee Vetting_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Repair queued
Attachment 5. Eligibility for Million Hearts Hospitals and Health Systems Recognition Program Participation.docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 5. Eligibility for Million Hearts Hospitals and Health Systems Recognition Program Participation.docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 4. Paperwork Reduction Act Project Determination Form_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 4. Paperwork Reduction Act Project Determination Form_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Repair queued
Attachment 3a. Published 60 Day Federal Register Notice_0920-1274_10212024.pdf Supplementary Document Uploaded 2025-08-05 Available
Attachment 3a. Published 60 Day Federal Register Notice_0920-1274_10212024.pdf Supplementary Document Uploaded 2025-08-05 Repair queued
Attachment 2a. Currently Approved Data Collection Tool 1_Application_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 2a. Currently Approved Data Collection Tool 1_Application_0920-1274.docx Supplementary Document Uploaded 2025-08-05 Repair queued
Attachment 1. Public Health Service Act [42 USC241].docx Supplementary Document Uploaded 2025-08-05 Available
Attachment 1. Public Health Service Act [42 USC241].docx Supplementary Document Uploaded 2025-08-05 Repair queued
1274 Att 8 Proposed Changes to App.docx Supplementary Document Uploaded 2022-07-14 Available
1274 Att 8 Proposed Changes to App.docx Supplementary Document Uploaded 2022-07-14 Repair queued
1274 Att 7 App to Designee Vetting.docx Supplementary Document Uploaded 2022-07-14 Available
1274 Att 7 App to Designee Vetting.docx Supplementary Document Uploaded 2022-07-14 Repair queued
1274 Att 6 Elig for Million Hearts Prog Part.docx Supplementary Document Uploaded 2022-07-14 Available
1274 Att 6 Elig for Million Hearts Prog Part.docx Supplementary Document Uploaded 2022-07-14 Repair queued
1274 Att 5 Project Deter.pdf Supplementary Document Uploaded 2022-07-14 Available
1274 Att 5 Project Deter.pdf Supplementary Document Uploaded 2022-07-14 Repair queued
1274 Att 3 Dear Colleague Ltr.docx Supplementary Document Uploaded 2022-07-14 Available
1274 Att 3 Dear Colleague Ltr.docx Supplementary Document Uploaded 2022-07-14 Repair queued
1274 Att 4 Pub 60-Day FRN.pdf Supplementary Document Uploaded 2022-07-14 Available
1274 Att 4 Pub 60-Day FRN.pdf Supplementary Document Uploaded 2022-07-14 Repair queued
18VJ Att 5a-b Followup Materials Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
18VJ Att 5a-b Followup Materials Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
19TG Att 4b. Confirmation Email Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
19TG Att 4b. Confirmation Email Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
19TG Att 3. Introduction Final.docx Supplementary Document Uploaded 2019-08-01 Available
19TG Att 3. Introduction Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
19TG Att 1b. Authorizing Legislation Final.docx Supplementary Document Uploaded 2019-08-01 Available
19TG Att 1b. Authorizing Legislation Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
19TG Att 1a. Authorizing Legislation PHSA Final.docx Supplementary Document Uploaded 2019-08-01 Available
19TG Att 1a. Authorizing Legislation PHSA Final.docx Supplementary Document Uploaded 2019-08-01 Repair queued
Support Statement B_0920-1274.docx Supporting Statement B Uploaded 2025-08-05 Available
Support Statement B_0920-1274.docx Supporting Statement B Uploaded 2025-08-05 Repair queued
Support Statement A_0920-1274_OIRA 9.9.25_HS_Clean.docx Supporting Statement A Uploaded 2025-09-17 Available
Support Statement A_0920-1274.docx Supporting Statement A Uploaded 2025-08-05 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
237208 Interview Guide Form ModifiedCommunications Interview Guide
237208 Interview Guide Form Modified
237207 Program Application Form ModifiedData Collection Application
237207 Program Application Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
09/30/2028 36 Months From Approved 10/31/2025
80 0 80
149 0 148
0 0 7,964





Reginfo record details
2
table that charts list of burden
IC Title Form No. Form Name
Interview Guide 0920-1274
Program Application 0920-1274

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 80 80 0 0 0 0
Annual Time Burden (Hours) 149 148 0 1 0 0
Annual Cost Burden (Dollars) 0 7,964 0 -7,964 0 0


Reginfo record details
  No