[NCCHPHP] Comprehensive Evaluations of the WISEWOMAN Programs, The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program

ICR 202504-0920-030

OMB: 0920-1453

Federal Form Document

Forms and Documents

Document Name	Status
Form 0920-1453 Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a) Form and Instruction	Modified
Form 0920-1453 Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c) Form and Instruction	Modified
Form 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b) Form and Instruction	Unchanged
Form 0920-1453 Cost Study Interview Guide_Partner (Attachment 5d) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l) Form and Instruction	Modified
Form 0920-1453 Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i) Form and Instruction	Modified
Form 0920-1453 Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CCL Partner Interview Guide WW (Attachment 3o) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n) Form and Instruction	Modified
Form 0920-1453 Eval Assessment TBC Partner Interview Guide WW (Attachment 3k) Form and Instruction	Modified
Form 0920-1453 Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CQM Partner Interview Guide WW (Attachment 3g) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f) Form and Instruction	Modified
Form 0920-24FI Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a) Form and Instruction	Unchanged
Form 0920-24FI Cost Study Interview Guide_Recipient (Attachment 5c) Form and Instruction	Unchanged
Form 0920-1453 Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j) Form and Instruction	Modified
Form 0920-1453 Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g) Form and Instruction	Modified
Form 0920-1453 Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c) Form and Instruction	Modified
Form 0920-1453 Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l) Form and Instruction	Modified
Form 0920-1453 Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i) Form and Instruction	Modified
Form 0920-1453 Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e) Form and Instruction	Modified
Form 0920-1453 Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d) Form and Instruction	Modified
Form 0920-1453 Evaluability Assessment Nomination Form_WW (Attachment 3b) Form and Instruction	Modified
Form 0920-1453 Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a) Form and Instruction	Modified
Change Request Memo - Template NCCDPHP EPET Comp Eval 4_18_25.docx Justification for No Material/Nonsubstantive Change	2025-04-30
SSB_VF_2025.04.29.docx Supporting Statement B	2025-04-30
SSA_VF_2025.04.29.docx Supporting Statement A	2025-04-30
Att 2c. 42 USC Section 241a.docx Supplementary Document	2024-11-01
Att 2f. FY 2023 Consolidated Appropriations Act.pdf Supplementary Document	2024-10-31
Att 2e. 42 USC 300I.docx Supplementary Document	2024-10-31
Att 2d. 42 USC 300n-4a.docx Supplementary Document	2024-10-31
Att 2b. 42 USC 300u-11.pdf Supplementary Document	2024-10-31
Att 2a. 42 USC 247b.pdf Supplementary Document	2024-10-31
Att 1c. CDC-RFA-DP-23-0003_Revised_Wisewoman.pdf Supplementary Document	2024-10-08
Att 1b. CDC-RFA-DP-23-0005_Innovative.pdf Supplementary Document	2024-10-08
Att 1a. CDC-RFA-DP-23-0004_National.pdf Supplementary Document	2024-10-08

IC Document Collections

IC ID	Document Title	Status
272080	Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a) Form and Instruction	Modified
272079	Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c) Form and Instruction	Modified
272078	Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b) Form and Instruction	Unchanged
272076	Cost Study Interview Guide_Partner (Attachment 5d) Form and Instruction	Modified
272075	Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m) Form and Instruction	Modified
272074	Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l) Form and Instruction	Modified
272073	Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i) Form and Instruction	Modified
272071	Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h) Form and Instruction	Modified
272070	Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e) Form and Instruction	Modified
272069	Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d) Form and Instruction	Modified
272067	Eval Assessment CCL Partner Interview Guide WW (Attachment 3o) Form and Instruction	Modified
272066	Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n) Form and Instruction	Modified
272064	Eval Assessment TBC Partner Interview Guide WW (Attachment 3k) Form and Instruction	Modified
272063	Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j) Form and Instruction	Modified
272061	Eval Assessment CQM Partner Interview Guide WW (Attachment 3g) Form and Instruction	Modified
272059	Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f) Form and Instruction	Modified
272058	Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a) Form and Instruction	Unchanged
272038	Cost Study Interview Guide_Recipient (Attachment 5c) Form and Instruction	Unchanged
271848	Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k) Form and Instruction	Modified
271847	Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j) Form and Instruction	Modified
271846	Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g) Form and Instruction	Modified
271845	Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f) Form and Instruction	Modified
271844	Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c) Form and Instruction	Modified
271843	Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b) Form and Instruction	Modified
271842	Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m) Form and Instruction	Modified
271841	Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l) Form and Instruction	Modified
271840	Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i) Form and Instruction	Modified
271839	Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h) Form and Instruction	Modified
271838	Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e) Form and Instruction	Modified
271497	Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d) Form and Instruction	Modified
271477	Evaluability Assessment Nomination Form_WW (Attachment 3b) Form and Instruction	Modified
271476	Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a) Form and Instruction	Modified