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Five-Year Regional Work Plan Template
Please complete the survey below.Thank you!
Page 1
Form Approved
OMB 0920-1437
Exp. 06/30/2027
Public reporting burden of this collection of information is estimated to average 120 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the
collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of
information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer;
1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-1437).
For the identified focus area, how many activities
support Objective 1?
HHS Region Number
Funded Institution
Period of Performance Start Date
Period of Performance End Date
Date of Completion of Workplan
In this Document:
- Section 1 - Focus Area, Priorities, Multi-Year Objectives and Activities
- Section 2- Partner, Roles, and Resources Needed to Accomplish Objectives
- Section 3- General Questions A Five-Year Regional Work Plan should include:
- Priority areas and objectives, and at least 3 focus areas on ways State, Tribal, Local, and Territorial (STLT) and
relevant partners can benefit from use of new or enhanced public health preparedness and response (PHPR)
evidence-based strategies or interventions (EBSIs).
- Prioritized EBSIs to implement.
- Capability and capacity of STLT health departments and relevant partners to implement and evaluate activities to
meet objectives.
- Sustainability plan for implementation of evidence-based practice in the region beyond the five-year period.
Guidance on completing the work plan for HHS Regions:
- Identify at least 3 regional STLT focus area(s) that would benefit from translation, dissemination, and evaluation of
promising research findings or evidence-informed or evidence-based practices. The focus areas should remain
consistent throughout the performance period.
- Regional STLT PHPR focus areas may range from public health emergency type, Public Health Emergency
Preparedness (PHEP) capability domain, and target population.
- The workplan should also cover known strategies or interventions, plans to implement each strategy or
intervention, or the development and evaluation of new approaches.
- Establish minimum of 3 multi-year objectives per focus area and provide a detailed description of the objective
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supported by key data, policy, and/or literature findings.
- Ensure objectives meet the SMART criteria.
- Identify activities to meet objectives in Five-Year Regional Work Plans.
- Incorporate health equity and population-specific considerations and how it will be addressed within each focus
area. If the objective does not include these specifications, please indicate why.
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Regional Focus Area 1
Description of Focus Area (i.e., Strengthening risk
communication activities)
Regional Priority Topic (e.g., Communications)
Description of Priority Topic
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Describe the objective in detail and how it will
impact the focus area supported by data, policy, or
other literature findings.
Start date
End date
How will progress towards achieving each objective be
monitored and evaluated?
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What is the activity?
Target Date of Completion
Responsible Position or Party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Setting
Regional
State
Territorial
Population focus
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
If Population focus "Other", specify
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Category
Program
Research and evaluation
Activity 1: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 1: Collaboration and Coordination
For Activity 1, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 1: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Responsible Position or Party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status Activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the incompletion
Please specify the reason for the extension
Setting
Regional
Population focus
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State
Territorial
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
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If Population focus "Other", specify
Category
Program
Research and evaluation
Activity 2: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 2: Collaboration and Coordination
For Activity 2, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 2: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Responsible Position or Party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Setting
Regional
Population focus
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State
Territorial
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
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If Population Focus "Other", specify
Category
Program
Research and evaluation
Activity 3: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 3: Collaboration and Coordination
For Activity 3, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 3: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Responsible position or party
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Progress or Process Measure(s)
Setting
Regional
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State
Territorial
Local
Tribal
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Population focus
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
If Population Focus "Other", specify
Category
Program
Research and evaluation
Activity 4: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 4: Collaboration and Coordination
For Activity 4, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 4: Health Equity Considerations
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Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Responsible position or party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Setting
Regional
Population focus
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State
Territorial
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
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If Population Focus "Other", specify
Category
Program
Research and evaluation
Activity 5: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 5: Collaboration and Coordination
For Activity 5, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 5: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Responsible position or party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Setting
Regional
Population focus
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State
Territorial
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
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If Population Focus "Other", specify
Category
Program
Research and evaluation
Activity 6: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 6: Collaboration and Coordination
For Activity 6, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 6: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Responsible position or party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Setting
Regional
Population focus
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State
Territorial
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
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If Population Focus "Other", specify
Category
Program
Research and evaluation
Activity 7: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 7: Collaboration and Coordination
For Activity 7, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 7: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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What is the activity?
Target Date of Completion
Responsible position or party
Progress or Process Measures of the Activity (as indicated in the Cooperative Agreement Workplan Template)
Status of activity
Pending
In Progress
Delayed
Extension (Cost)
Extension (No-cost)
Complete
Incomplete
Please specify the reason for the delay
Please specify the reason for the extension
Please specify the reason for the incompletion
Setting
Regional
Population focus
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State
Territorial
Local
Tribal
Vulnerable or at-risk
Underserved
African American
Hispanic/Latino
Asian American
Native American/American Indian
People with Limited English Proficiency
People living in rural areas
Low-income
Immigrant
Other
Not Applicable
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If Population Focus "Other", specify
Category
Program
Research and evaluation
Activity 8: Purpose
Select the purpose of the identified activity.
*If cross-cutting, select all that apply.
Identify, translate, and disseminate promising
research findings or strategies into
evidence-informed or evidence-based practices (may
include conducting research related to public
health preparedness and response systems)
Improve awareness of evidence informed or
evidence-based practices and other relevant
scientific or public health information through
the development, evaluation, and dissemination of
trainings and training materials
Utilize and expand relevant technological and
analytical capabilities to inform public health
and medical preparedness and response efforts (may
include participation in drills and exercises and
training public health experts)
Provide technical assistance and expertise that
relies on evidence-based practices
Coordinate relevant activities to improve public
health preparedness and response as informed by
needs of the community or communities involved
Other
If Purpose "Other", specify
Activity 8: Collaboration and Coordination
For Activity 8, describe collaboration and
coordination activities (e.g., partnerships) with
applicable state, territorial, local, and tribal
health department and officials, health care
facilities, and health care coalitions to improve
public health preparedness and response.
Activity 8: Health Equity Considerations
Has the coordinating body considered the evidence base documenting drivers of health disparities and inequities to
inform development of the objective?
Yes
No
Not applicable
If "Yes" to the above question, how? If "No", please explain why not.
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Are considerations for health equity integrated into the decision-making process when developing and framing the
objective to improve health outcomes?
Yes
No
Not Applicable
Has the objective considered the burden of social determinants of health on populations with access and functional
needs, low socioeconomic status, and communities experiencing racism?
Yes
No
Not Applicable
Are there known unintended positive or negative impacts on health equity?
Yes
No
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Not Applicable
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Describe potential partners who can support necessary
activities to accomplish the objective.
Describe potential roles and responsibilities for each
partner to accomplish the objective.
Describe administrative, financial, or technical
support resources needed to accomplish the objective.
Describe potential resources that may be provided by
the partner to accomplish the objective.
Describe potential barriers or issues that may be
encountered in accomplishing the objective.
Describe potential strategies to overcome barriers or
issues to accomplish the objective.
Describe any potential technical assistance required
and by whom to accomplish the objective.
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Within the HHS region, which organizations or groups,
if any, currently support activities in the focus area
of interest?
What search strategy was used to identify these
organizations or groups?
Do the organizations or groups have dedicated funds to
expand activities in the future for the focus area?
Who participated in the development of the objectives?
How many individuals participated in developing this
objective? (For Regions 1, 2, and 5 ONLY)?
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
Participant 1
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
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Geographical Location
Area of Expertise
Participant 2
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 3
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 4
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Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 5
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 6
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Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 7
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 8
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Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 9
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 10
11/19/2024 9:41am
projectredcap.org
Confidential
Page 35
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 11
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 12
11/19/2024 9:41am
projectredcap.org
Confidential
Page 36
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 13
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 14
11/19/2024 9:41am
projectredcap.org
Confidential
Page 37
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 15
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 16
11/19/2024 9:41am
projectredcap.org
Confidential
Page 38
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 17
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 18
11/19/2024 9:41am
projectredcap.org
Confidential
Page 39
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 19
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 20
11/19/2024 9:41am
projectredcap.org
Confidential
Page 40
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 21
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 22
11/19/2024 9:41am
projectredcap.org
Confidential
Page 41
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 23
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 24
11/19/2024 9:41am
projectredcap.org
Confidential
Page 42
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
Participant 25
Regional Coordinating Body Member Type
Federal
State
Local
Tribal
Territorial
Academic
Non-profit
Private
Healthcare
Other
If Regional Coordinating Body Member Type is "Other",
specify
Affiliation
Geographical Location
Area of Expertise
11/19/2024 9:41am
projectredcap.org
| File Type | application/pdf |
| File Modified | 2024-12-03 |
| File Created | 2024-12-03 |