PPHF—2012—Empowering Older Adults and Adults with Disabilities through Chronic Disease Self-Management Education (CDSME) Programs financed by 2012 Prevention and Public Health Funds (PPHF-2012)

Section 1: Original Website Package Proposed Data Collection Tools

List of Standardized Data Collection Tools

• Attachment A: Workshop Information Cover Sheet (PDF, 140KB)
• Attachment B: Participant Information Survey (PDF, 117KB)
• Attachment C: Attendance Log (PDF, 101KB)
• Attachment D: CDSME Semi-annual Program Progress Report (PDF, 150KB)
• Attachment E: CDSME Semi-annual Program Progress Report Instructions (PDF, 76KB)
• Attachment F: Organization Data Form (PDF, 138KB)
• Attachment G: Integrated Services Delivery System Assessment Tool (PDF, 312KB)

Section 2: Federal Register Notice and Comments

• 60 Day Federal Register Notice (PDF, 61KB)
• Comments to Federal Register Notice and Responses (DOC, 87KB)
• Attachment H: IRB Approval Letter (PDF, 175KB)
• Attachment I: Consent Form (PDF, 44KB)
• Attachment J: Group Leader Script (PDF, 35KB)
• Attachment K: Non-Disclosure Agreement (PDF, 27KB)

Section 3: Revised Data Collection Tools and Related Materials

List of Revised Data Collection Tools (DOC, 33KB)

• Attachment L: Workshop Information Cover Sheet (PDF, 43KB)
• Attachment M: Participant Information Survey (PDF, 37KB)
• Attachment N: Attendance Log (PDF, 33KB)
• Attachment O: Semi-Annual Performance Report Directions and Sample Template (PDF, 40KB)
• Attachment P: Organization Data Form (PDF, 133KB)
• Attachment Q: Integrated Services Delivery System Assessment Tool (PDF, 164KB)

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