OMB.report

Federal forms, ICRs, and supporting documents

OMB control number

Patient Centered Care Collaboration to Improve Minority Health Project

OMB 0990-0402 · HHS/HHSDM.

OMB 0990-0402

Latest Forms, Documents, and Supporting Material

Document Name
Attachment_1REVClean.docx Supplementary Document
OMB_Supporting_Statement_Part_B patient centered care OMB commentsREV2Clean.docx Supporting Statement B
Attachment_7-0990-PatientCentered.docx Supplementary Document
Attachment_5AREVClean.docx Supplementary Document
Attachment_4-0990-PatientCentered.docx Supplementary Document
Attachment_8-0990-PatientCentered.docx Supplementary Document
Attachment_6A-0990-PatientCentered.docx Supplementary Document
OMB_Supporting_Statement_Part_A patient centered care OMB commentsREV2Clean.docx Supporting Statement A
Houston- Participant,Provider, Facility Administrator, Local Hub. Steering Committee Members Other-survey
Chicago-Participants, Implementation Staff, Local Hub Members Other-questionnaire
Post Intervention: Diabetes or Hpertension or Hperteension and Diabetes Other-survey
Telephone Follow-up: Healthy Eating Other-survey
Telephone Follow-up; Being Active and Managing Stress Other-survey
First Home Visit Form: Diabetes or Hypertension or Hypertension and Diabetes Other-survey
Houston: Eligibility Screening Form1:Hpertension and Diabetes Other-survey
Pst-Intervention Questionnaire Other-questionnaire
Intake Questionnaire HELP Other-questionnaire
Screening Questionnaire Other-survey

All Historical Document Collections

201207-0990-005 Approved with change	New collection (Request for a new OMB Control Number)	2012-07-06
201201-0990-005 Withdrawn	New collection (Request for a new OMB Control Number)	2012-01-20