Key Takeaways

  • Check out these guidelines to understand what can and can't be changed when using the Administration for Community Living (ACL) data collection forms. 

  • These guidelines apply to both chronic disease self-management education and falls prevention grants.

While all Administration for Community Living grantees for CDSME and falls prevention must collect specific required data elements (see required data collection tools for CDSME and falls prevention), some grantees may opt to collect additional workshop and/or participant information. Here are some recommendations on how to modify these forms.  


  • Submit any modified versions of the data collection tools to your ACL Program Officer and NCOA Technical Assistance Liaison for their review and approval before using them. Be sure to track and highlight any changes you have made.
  • Add any required questions to pre-existing forms as long as they adhere to other standards set forth in this document. Your points of contact at ACL and NCOA will determine whether the information on your pre-existing forms can be intermingled with the required data elements or if it should be collected on a separate page(s).
  • Add your organization’s name, logo, and tailor the forms to fit your organization’s preferred formatting.
  • Remove the OMB reference #, expiration date, and Paperwork Reduction Act statement from modified forms.
  • Add any “optional” questions to your forms, that are in the Healthy Aging Programs Integrated Database (HAPID), if you find them useful. These questions are marked as “optional” in the form fields in each database. 
  • Continue collecting data from the previous data collection tools, if you found them to be important for your evaluation purposes. However, these should be entered in an independent database, as they will not be available for entry into HAPID.


  • Do not change the wording of the required questions.
  • Do not change the wording of any answer options for any required questions, and do not add any new answer options.
  • Do not change the order in which the required questions are presented.
  • Do not forget to send the ‘modified’ data collection forms to your ACL Program Officer and NCOA Technical Assistance Liaison before commencing data collection. 

Have  a question? Submit a ticket for help through HAPID.