CHW Program Modules

National Hypertension Control Initiative

OMB: 0990-0482

IC ID: 266245

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Information Collection (IC) Details

View Information Collection (IC)

CHW Program Modules
 
No New
 
Mandatory
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction Module 1 Community Clinical Linkages: Enhancing Collabora􀆟ve Care PrePost assessment CHW Pilot Program - 1 Enhancing Collaborative Care.pdf Yes Yes Fillable Fileable
Form and Instruction Module 2 High blood Pressure Awareness: All about High Blood Pressure PrePost assessment CHW Pilot Program - 2 All about High Blood Pressure.pdf Yes Yes Fillable Fileable
Form and Instruction Module 3 Being Proactive with HBP: Identifying Risk Factors and Implementing Effective Program PrePost assessment CHW Pilot Program - 3 Being Proactive with High Blood Pressure.pdf Yes Yes Fillable Fileable
Form and Instruction Module 4 Blood Pressure Screenings: Assessing BP and Interpreting Readings PrePost assessment CHW Pilot Program - 4 Assessing and Interpreting BP Results.pdf Yes Yes Fillable Fileable
Form and Instruction Module 5 Preventive Strategies for High Blood Pressure: Promoting Healthy Lifestyles PrePost assessment CHW Pilot Program - 5 Preventative Strategies for High Blood Pressure.pdf Yes Yes Fillable Fileable
Form and Instruction Module 6 Social Determinants of Health: Assessment, Navigation, and Monitoring PrePost assessment CHW Pilot Program - 6 Social Determinants of Health.pdf Yes Yes Fillable Fileable
Form and Instruction Module 7 Care Coordination: Effective Collaboration with Health Care Professionals PrePost assessment CHW Pilot Program - 7 Care Coordination.pdf Yes Yes Fillable Fileable

Community and Social Services Social Services

 

300 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,200 0 4,200 0 0 0
Annual IC Time Burden (Hours) 700 0 700 0 0 0
Annual IC Cost Burden (Dollars) 16,793 0 16,793 0 0 0

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            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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