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

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 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 0920-1453 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 0920-24FI 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 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_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 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_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 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_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 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 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 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 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 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 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 0920-1453 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 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 0920-24FI 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_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 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_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 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_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 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 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 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 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 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 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 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_WW (Attachment 3b) Form and Instruction	Modified
Form 0920-1453 Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a) 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
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
SSB_VF_2025.04.29.docx Supporting Statement B	2025-04-30
SSA_VF_2025.04.29.docx Supporting Statement A	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 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 2f. FY 2023 Consolidated Appropriations Act.pdf Supplementary Document	2024-10-31
Att 2e. 42 USC 300I.docx 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 2d. 42 USC 300n-4a.docx Supplementary Document	2024-10-31
Att 2b. 42 USC 300u-11.pdf 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 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 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 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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
271476	Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a) Form and Instruction	Modified

ICR Details

OMB Control No: 0920-1453	ICR Reference No: 202504-0920-030
Status: Active	Previous ICR Reference No: 202410-0920-005
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-1453-25-0109
Title: [NCCHPHP] Comprehensive Evaluations of the WISEWOMAN Programs, The National Cardiovascular Health Program, The Innovative Cardiovascular Health Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/09/2025
	Date Received in OIRA: 05/01/2025
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2027	12/31/2027	12/31/2027
Responses	316	0	316
Time Burden (Hours)	484	0	484
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of the project is to conduct a comprehensive implementation and outcome evaluation to assess the unique contributions of The National Cardiovascular Health Program (The National CVH Program), The Innovative Cardiovascular Health Program (The Innovative CVH Program), and Well-Integrated Screening and Evaluation of Women Across the Nation (WISEWOMAN) cooperative agreements to identify promising cardiovascular disease (CVD) prevention and management practices that can be scaled and replicated, advance health equity, and the transformation of health systems for improved CVD prevention and management. The programs work together to create efficiencies and improve outcomes in jurisdictions that receive funding for two or more of the cooperative agreements. This Evaluation aims to assess implementation, assess the extent to which short-term, intermediate, and long-term outcomes have been met, and estimate the costs involved in program implementation. This Non-Substantive Change Request is submitted to revise questions to align with recent executive orders, EO 14168 and EO 14151. There is no change anticipated to the currently approved burden hours.

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Authorizing Statute(s): US Code: 42 USC 247b Name of Law: Project grants for Preventive Health Services
   US Code: 42 USC Title IV, Sec. 4002, 300u-11 Name of Law: Affordable Care Ac, Prevention and Helath Fund
   US Code: 42 USC Title XV, Sec. 1509 Name of Law: Public Health Service Act
   US Code: 42 USC Sec. 1502, 3001 Name of Law: Public Health Service Act
   PL: Pub.L. 117 - 328 136 STAT. 4459 Name of Law: An Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 38151	05/07/2024
30-day Notice:	Federal Register Citation:	Citation Date:
	89 FR 88778	11/08/2024
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 32

IC Title	Form No.	Form Name
Comprehensive Evaluation Resource Use and Cost Inventory Tool_Partner (Attachment 5b)	0920-24FI	Cost Study – Partner Interview Guide
Comprehensive Evaluation Resource Use and Cost Inventory Tool_Recipient (Attachment 5a)	0920-24FI	Comprehensive Evaluation Resource Use and Cost Inventory Tool (Recipient)
Cost Study Interview Guide_Partner (Attachment 5d)	0920-1453	Att 5d. Cost Study_Interview Guide_Partners_rev 2025
Cost Study Interview Guide_Recipient (Attachment 5c)	0920-24FI	Cost Study – Recipient Interview Guide
Eval Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 3n)	0920-1453	Att 3n. Eval Assessment_CCL_Partner_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment CCL Partner Interview Guide WW (Attachment 3o)	0920-1453	Att 3o. Eval Assessment_CCL_Partner_Interview Guide_WW_rev 2025
Eval Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 3l)	0920-1453	Att 3l. Eval Assessment_CCL_Recipient_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment CCL Recipient Interview Guide WW (Attachment 3m)	0920-1453	Att 3m. Eval Assessment_CCL_Recipient_Interview Guide_WW_rev 2025
Eval Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 3f)	0920-1453	Att 3f. Eval Assessment_CQM_Partner_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment CQM Partner Interview Guide WW (Attachment 3g)	0920-1453	Att 3g. Eval Assessment_CQM_Partner_Interview Guide_WW_rev 2025
Eval Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 3d)	0920-1453	Att 3d. Eval Assessment_CQM_Recipient_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment CQM Recipient Interview Guide WW (Attachment 3e)	0920-1453	Att 3e. Eval Assessment_CQM_Recipient_Interview Guide_WW_rev 2025
Eval Assessment LC Interview Guide_NCHP_ICHP (Attachment 3c)	0920-1453	Att 3c. Eval Assessment_LC_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 3j)	0920-1453	Att 3j. Eval Assessment_TBC_Partner_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment TBC Partner Interview Guide WW (Attachment 3k)	0920-1453	Att 3k. Eval Assessment_TBC_Partner_Interview Guide_WW_rev 2025
Eval Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 3h)	0920-1453	Att 3h. Eval Assessment_TBC_Recipient_Interview Guide_NCHP_ICHP_rev 2025
Eval Assessment TBC Recipient Interview Guide WW (Attachment 3i)	0920-1453	Att 3i. Eval Assessment_TBC_Recipient_Interview Guide_WW_rev 2025
Evaluability Assessment Nomination Form_NCHP_ICHP (Attachment 3a)	0920-1453	Att 3a. Evaluability Assessment Nomination Form_NCHP_ICHP_rev 2025
Evaluability Assessment Nomination Form_WW (Attachment 3b)	0920-1453	Att 3b. Evaluability Assessment Nomination Form_WW_rev 2025
Ex Assessment CCL Partner Interview Guide NCHP_ICHP (Attachment 4l)	0920-1453	Att 4l. Ex Assessment_CCL_Partner_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment CCL Partner Interview Guide_WW (Attachment 4m)	0920-1453	Att 4m. Ex Assessment_CCL_Partner_Interview Guide_WW_rev 2025
Ex Assessment CCL Recipient Interview Guide NCHP_ICHP (Attachment 4j)	0920-1453	Att 4j. Ex Assessment_CCL_Recipient_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment CCL Recipient Interview Guide_WW (Attachment 4k)	0920-1453	Att 4k. Ex Assessment_CCL_Recipient_Interview Guide_WW_rev 2025
Ex Assessment CQM Partner Interview Guide NCHP_ICHP (Attachment 4d)	0920-1453	Att 4d. Ex Assessment_CQM_Partner_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment CQM Partner Interview Guide_WW (Attachment 4e)	0920-1453	Att 4e. Ex Assessment_CQM_Partner_Interview Guide_WW_rev 2025
Ex Assessment CQM Recipient Interview Guide NCHP_ICHP (Attachment 4b)	0920-1453	Att 4b. Ex Assessment_CQM_Recipient_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment CQM Recipient Interview Guide_WW (Attachment 4c)	0920-1453	Att 4c. Ex Assessment_CQM_Recipient_Interview Guide_WW_rev 2025
Ex Assessment LC Interview Guide NCHP_ICHP (Attachment 4a)	0920-1453	Att 4a. Ex Assessment_LC_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment TBC Partner Interview Guide NCHP_ICHP (Attachment 4h)	0920-1453	Att 4h. Ex Assessment_TBC_Partner_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment TBC Partner Interview Guide_WW (Attachment 4i)	0920-1453	Att 4i. Ex Assessment_TBC_Partner_Interview Guide_WW_rev 2025
Ex Assessment TBC Recipient Interview Guide NCHP_ICHP (Attachment 4f)	0920-1453	Att 4f. Ex Assessment_TBC_Recipient_Interview Guide_NCHP_ICHP_rev 2025
Ex Assessment TBC Recipient Interview Guide_WW (Attachment 4g)	0920-1453	Att 4g. Ex Assessment_TBC_Recipient_Interview Guide_WW_rev 2025

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	316	316	0	0	0	0
Annual Time Burden (Hours)	484	484	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $708,783

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 05/01/2025

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