Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being

OMB 0920-1122

The purpose of CH STRONG is to assess barriers to care, quality of life, social and educational outcomes, and transition of care among adults born with congenital heart defects (CHD).

The latest form for Congenital Heart Survey to Recognize Outcomes, Needs, and Well-Being expires 2021-05-31 and can be found here.

Latest Forms, Documents, and Supporting Material

Document Name
Form 0920-1122 Spanish Contact Information Form Form
Form 0920-1122 English Contact information Form Form
Form 0920-1122 Congential Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) Form
Att. 19 - Spanish Contact Info.pdf Supplementary Document
Att. 18 - Contact Info.pdf Supplementary Document
Att. 17 - Spanish Letter to Mother.pdf Supplementary Document
Att. 16 - Letter to Mother.pdf Supplementary Document
CH STRONG_SupSta Part A_031318.docx Supporting Statement A
Att. 15 - Spanish Consent.pdf Supplementary Document
Att. 14 - Spanish Intro.pdf Supplementary Document
Att. 12 - References.pdf Supplementary Document
Att. 10 - Reminder Phone Call Script.pdf Supplementary Document
Att. 9 - Postcards.pdf Supplementary Document
Att. 4 - Intro Letter.pdf Supplementary Document
Att. 5 - Consent.pdf Supplementary Document
Att. 8 - IRB Approval (Renewal).pdf Supplementary Document
Att. 7 - External Reviewers.pdf Supplementary Document
Att. 2 - 60dy Published FRN.pdf Supplementary Document
Att. 1 - Authorizing Legislation.pdf Supplementary Document
CH STRONG_Supporting Statement Part B_2018 jan9 clean.docx Supporting Statement B
Spanish Contact Information Form Form
English Contact information Form Form
Congential Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG) Form

All Historical Document Collections

201803-0920-008 Approved without change	Reinstatement with change of a previously approved collection	2018-03-14
201607-0920-007 Approved without change	No material or nonsubstantive change to a currently approved collection	2016-07-21
201601-0920-013 Approved with change	New collection (Request for a new OMB Control Number)	2016-02-12

OMB Details

Congential Heart Survey To Recognize Outcomes, Needs, and well-beinG (CH STRONG)

Federal Enterprise Architecture: Health - Public Health Monitoring

Form 0920-1122	CHSTRONG Encuesta Cardiaca Congenita para Reconocer los Resultados, las Necesidades y el Bienestar	Fillable Fileable	Form
Form 0920-1122	CHSTRONG Cogenital Heart Survey To Recognize Outcomes, Needs, and well-beinG	Fillable Fileable	Form

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.