Information Collection Request

[NCCDPHP] Million Hearts Hypertension Control Challenge

ICR 202601-0920-005 · OMB 0920-0976 · Active

Forms and Documents

Forms and supporting documents for this ICR
DocumentTypeStatusAvailability
Form 0920-0976 Interview Guide Form Modified Available
Form 0920-0976 Interview Guide: Million Hearts® Hypertension Control Champion Form and Instruction Modified Available
Form 0920-0976 Interview Guide Form and Instruction Modified Missing upstream
Form 0920-0976 Data Verification Form Form Modified Available
Form 0920-0976 Million Hearts® Hypertension Control Champion Data Verification Form Form and Instruction Modified Available
Form 0920-0976 Million Hearts® Hypertension Control Champion Data Verification Form Form and Instruction Modified Missing upstream
Form 0920-0976 Application Form Form Modified Available
Form 0920-0976 Application Form Form Modified Repair queued
Response to comment 2 of 2_MH2_Aug 2025.docx Public Comments Uploaded 2026-01-28 Available
Response to comment 1 of 2_MH2_Aug 2025.docx Public Comments Uploaded 2026-01-28 Available
Attachment 10. Contractors Request for Chart Part 2 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 10. Contractors Request for Chart Part 2 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Missing upstream
Attachment 9. Contractors Request for Charts Part 1 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 9. Contractors Request for Charts Part 1 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Missing upstream
Attachment 8. MH Hypertension Control Challenge Project Determination_12.09.25.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 8. MH Hypertension Control Challenge Project Determination_12.09.25.docx Supplementary Document Uploaded 2026-01-28 Repair queued
Attachment 7. Example Business Associate Agreement 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 7. Example Business Associate Agreement 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Missing upstream
Attachment 6. Screenshot of Champions Application_2025.jpeg Supplementary Document Uploaded 2026-01-28 Available
Attachment 6. Screenshot of Champions Application_2025.jpeg Supplementary Document Uploaded 2026-01-28 Repair queued
Attachment 3b. Confirmation email 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 3b. Confirmation email 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Repair queued
Attachment 1b. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 1b. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Repair queued
Attachment 1a. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Available
Attachment 1a. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2026-01-28 Missing upstream
Attachment 10. Contractors Request for Chart Part 2 0920-0976.docx Supplementary Document Uploaded 2022-09-29 Available
Attachment 10. Contractors Request for Chart Part 2 0920-0976.docx Supplementary Document Uploaded 2022-09-29 Repair queued
Attachment 9. Contractors Request for Charts Part 1 0920-0976.docx Supplementary Document Uploaded 2022-09-29 Available
Attachment 9. Contractors Request for Charts Part 1 0920-0976.docx Supplementary Document Uploaded 2022-09-29 Missing upstream
Attachment 8. Project Determination_Hypertension Control Challenge.docx Supplementary Document Uploaded 2022-09-29 Available
Attachment 8. Project Determination_Hypertension Control Challenge.docx Supplementary Document Uploaded 2022-09-29 Repair queued
Attachment 7. Example Business Associate Agreement 0920-0976.docx Supplementary Document Uploaded 2022-09-29 Available
Attachment 7. Example Business Associate Agreement 0920-0976.docx Supplementary Document Uploaded 2022-09-29 Missing upstream
Attachment 2. Published 60 Day FRN.pdf Supplementary Document Uploaded 2022-10-18 Available
Attachment 2. Published 60 Day FRN.pdf Supplementary Document Uploaded 2022-10-18 Repair queued
Attachment 1c. Office of Management and Budget Guidance on the Use of Challenges 0920-0976.pdf Supplementary Document Uploaded 2016-09-19 Available
Attachment 1c. Office of Management and Budget Guidance on the Use of Challenges 0920-0976.pdf Supplementary Document Uploaded 2016-09-19 Repair queued
Attachment 1b. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2022-10-18 Available
Attachment 1b. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2022-10-18 Repair queued
Attachment 1a. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2022-10-18 Available
Attachment 1a. Authorizing Legislation 0920-0976.docx Supplementary Document Uploaded 2022-10-18 Repair queued
SSB Revised_2025.docx Supporting Statement B Uploaded 2026-01-28 Available
SSB Revised_2025.docx Supporting Statement B Uploaded 2026-01-28 Available
SSA Revised_12-18-2025.docx Supporting Statement A Uploaded 2026-01-28 Available
SSA Revised_12-18-2025.docx Supporting Statement A Uploaded 2026-01-28 Repair queued

IC Document Collections

Information collection document groups
IC IDCollectionTypeStatusForm
206922 Interview Guide Form ModifiedInterview Guide
206922 Interview Guide Form and Instruction ModifiedInterview Guide: Million Hearts® Hypertension Control Champion
206922 Interview Guide Form and Instruction Modified
206921 Million Hearts® Hypertension Control Champion Data Verification Form Form ModifiedData Verification Form
206921 Million Hearts® Hypertension Control Champion Data Verification Form Form and Instruction ModifiedMillion Hearts® Hypertension Control Champion Data Verification Form
206921 Million Hearts® Hypertension Control Champion Data Verification Form Form and Instruction Modified
206920 Application Form Form ModifiedApplication Form
206920 Application Form Form Modified

ICR Details

Reginfo record details
table that charts list comparision
  Inventory as of this Action Requested Previously Approved
03/31/2029 36 Months From Approved 03/31/2026
175 0 275
165 0 215
0 0 0





Reginfo record details
3
table that charts list of burden
IC Title Form No. Form Name
Application Form 0920-0976
Interview Guide 0920-0976, 0920-0976 ,  
Million Hearts® Hypertension Control Champion Data Verification Form 0920-0976, 0920-0976 ,  

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 175 275 0 -100 0 0
Annual Time Burden (Hours) 165 215 0 -50 0 0
Annual Cost Burden (Dollars) 0 0 0 0 0 0


Reginfo record details
  No