[NCCDPHP] Community Health Workers for COVID Response and Resilient Communities’ National Evaluation

ICR 202306-0920-005

OMB: 0920-1411

Federal Form Document

Forms and Documents

Document Name	Status
Community Health Workers CHW Survey Form and Instruction	New
Community Health Workers Recipient Survey Form and Instruction	New
Att 7a - CHW Survey human subjects document exemption determination.pdf Supplementary Document	2023-06-09
Att 7 - CCR Recipient Survey human subjects document exemption determination.docx Supplementary Document	2023-06-09
Att 6 - 60-day Federal Register Notice.pdf Supplementary Document	2023-06-09
Att 5c - CHW Survey Reminder Email .docx Supplementary Document	2023-06-09
Att 5b - CHW Survey Introductory Email .docx Supplementary Document	2023-06-09
Att 4d - CCR Recipient Survey Reminder.docx Supplementary Document	2023-06-09
Att 4c - CCR Recipient Survey Introductory Email.docx Supplementary Document	2023-06-09
Att 4b- CCR Evaluation Surveys Announcement Email.docx Supplementary Document	2023-06-09
Att 3 - CCR National Evaluation Question Matrix.docx Supplementary Document	2023-06-09
Att 2 - DP21-2109 Logic Model.pdf Supplementary Document	2023-06-09
Att 1 Authorizing Legislation.pdf Supplementary Document	2023-06-09
0920-23AH CHW_SS Part B.docx Supporting Statement B	2023-06-08
0920-23AH CHW_SS Part A_final.docx Supporting Statement A	2023-06-08

IC Document Collections

IC ID	Document Title	Status
260599	Community Health Workers CHW Survey Form and Instruction	New
260598	Community Health Workers Recipient Survey Form and Instruction	New