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

Latest forms, documents, and information collections
Document	Type
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 2014 Parent Focus Group Protocol	Form and Instruction
Form Form #5 Other States Interview Guide	Form and Instruction
Form 9 2014 Health Care Organization Staff Interview Guide	Form and Instruction
Form 8 2012 Health Care Organization Staff Interview Guides	Form and Instruction
Form 5 2014 Stakeholder Interview Guide	Form and Instruction
Form 4 2012 Stakeholder Interview Guides	Form and Instruction
Form 3 2014 Implementation Staff Interview Guide	Form and Instruction
Form 2 2012 Implementation Staff Interview Guide	Form and Instruction
Form 1 2014 Key Staff Interview Guide	Form and Instruction
Form Form #1 Key Staff Interview Guide	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
Health Care Provider Interviews	Form and Instruction
Stakeholder Interviews	Form and Instruction
Stakeholder Interviews	Form and Instruction
Implementation Staff Interviews	Form and Instruction
Implementation Staff Interviews	Form and Instruction
Key Staff Interviews	Form and Instruction
Key Staff Interviews	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
201402-0935-001	Revision of a currently approved collection	2014-02-25		Approved without change
201110-0935-003	New collection (Request for a new OMB Control Number)	2011-10-27		Approved with change