OMB control number

Evaluation of the Children's Health Insurance Program Reauthorization Act of 2009 (CHIPRA) Quality Demonstration Grant Program

OMB 0935-0190 · HHS/AHRQ.

OMB 0935-0190

Latest Forms, Documents, and Supporting Material

Document Name
Form 15 Adolescent Pre-Focus Group Interview Script Form and Instruction
Form 14 Adolescent Telephone Screening Script Form and Instruction
Form 13 Adolescent Focus Group Protocol Form and Instruction
Form 12 Parent Pre-Focus Group Interview Script Form and Instruction
Form 11 Parent Telephone Screening Script Form and Instruction
Form 10 Parent Focus Group Protocol Form and Instruction
Form Form #5 Non-demonstration States Interviews Form and Instruction
Form 8 Health Care Provider Interviews Form and Instruction
Form 4 Stakeholder Interviews Form and Instruction
Form 2 Implementation Staff Interviews Form and Instruction
Form Form #1 Key Staff Interviews Form and Instruction
CHIPRASupporting Statement Part B -- Revised Feb 14 2014.docx Supporting Statement B
Attachment A - Authorizing Legislation.docx Supplementary Document
Attachment X- Confidentiality Pledge.docx Supplementary Document
Attachment W- Provider Site Recruitment Letters 7-23-2013.docx Supplementary Document
Attachment V - Technical Expert Panel Members.docx Supplementary Document
Attachment T- CHIPRA Quality Demonstration Evaluation Research Questions.docx Supplementary Document
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx Supplementary Document
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx Supplementary Document
Attachment Q- 2014 Adolescent Focus Group Recruitment Materials.docx Supplementary Document
Attachment O- Informed Consent Forms.docx Supplementary Document
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx Supplementary Document
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx Supplementary Document
Attachment L- 2014 Parent Focus Group Recruitment Materials.docx Supplementary Document
Attachment O- Informed Consent Forms.docx Supplementary Document
Attachment C- Interview Request and Confirmation Emails.docx Supplementary Document
Attachment C- Interview Request and Confirmation Emails.docx Supplementary Document
Attachment C- Interview Request and Confirmation Emails.docx Supplementary Document
Attachment C- Interview Request and Confirmation Emails.docx Supplementary Document
CHIPRASupporting Statement Part A -- Revised Feb 14 2014.docx Supporting Statement A
Adolescent Pre-Focus Group Interview Script Form and Instruction
Adolescent Telephone Screening Script Form and Instruction
Adolescent Focus Group Protocol Form and Instruction
Parent Pre-Focus Group Interview Script Form and Instruction
Parent Telephone Screening Script Form and Instruction
Parent Focus Group Protocol Form and Instruction
Non-demonstration States Interviews Form and Instruction
Health Care Provider Interviews Form and Instruction
Stakeholder Interviews Form and Instruction
Implementation Staff Interviews Form and Instruction
Key Staff Interviews Form and Instruction

All Historical Document Collections

201402-0935-001 Approved without change	Revision of a currently approved collection	2014-02-25
201110-0935-003 Approved with change	New collection (Request for a new OMB Control Number)	2011-10-27