OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

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

OMB 0920-1122 ยท HHS/CDC.

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 is listed under ICR 201803-0920-008.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
DocumentType
Form 0920-1122 Spanish Contact Information FormForm
Form 0920-1122 English Contact information FormForm
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.docxSupporting 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.docxSupporting 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All Historical Document Collections

Historical document collections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

OMB Details

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

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
FormNameElectronic accessType
Form 0920-1122CHSTRONG Encuesta Cardiaca Congenita para Reconocer los Resultados, las Necesidades y el BienestarFillable FileableForm
Form 0920-1122CHSTRONG Cogenital Heart Survey To Recognize Outcomes, Needs, and well-beinGFillable FileableForm

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