Data Collection Tools for Chronic Disease Self-Management Education

CDSME Form Update (2023)

The Administration for Community Living and the Office of Management and Budget revised the chronic disease self-management education grant data collection tools. The new forms are available as of May 2023. Updates on transitioning to the new forms:

• Data entry: NCOA is working to incorporate the new OMB Forms into the Healthy Aging Programs Integrated Database (HAPID®).
• Instructions for ACL Grantees:
  • The new ACL, OMB-approved CDSME forms are to be used by all 2023 CDSME Grantees, effective immediately for any workshops delivered.
  • All other CDSME Grantees (cohorts from 2022 and earlier) are allowed a grace period to transition to using the new OMB forms in the field. Be sure to distribute to your partner sites and facilitators ASAP.  ACL would like all existing users to be using only the new forms exclusively in the field by Sept. 1, 2023.
  • We anticipate that grantees from previous cohort years (2022 and earlier) will have a mixed batch of surveys to upload in the database through the rest of this calendar year, consisting of workshops using both the new and old forms. In HAPI-D, once you’ve selected the proper workshop (e.g. DSMP, CPSMP, Walk With Ease…), you’ll be prompted to select the relevant survey, which you can select by name and expiration date. 
  • For an update on collecting facilitator information using the Program Cover Sheet, review this guidance.

Training

Data Collection Tools

Download the forms by language below. Each file is a zip folder with the following forms: 

• Host/Implementation Organization Information Form
• Program Information Cover Sheet 
• Attendance Log 
• Participant Information Survey 
• Group Leader Script

CDSME Forms- Expiration 2026

If you require the surveys in another language not listed here, submit a ticket in the National Database or contact your NCOA technical assistance liaison.

CDSME Forms-Expiration 2022

View Falls Prevention Data Collection Tools.