Assessing the Diabetes Detection Initiative for Policy Decisions

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form No number DDI Patient Survey	Form	New	Available
Form No number Screening Questions for the DDI Patient Survey	Form	New	Available
Form No number DDI Health Leadership Clinic Survey	Form	New	Available
Supporting Statement B.doc	Supporting Statement B	Uploaded 2008-01-16	Available
Attachment E Methodology for Conducting Perceived Benefits Analysis.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment D Battelle IRB approval.pdf	Supplementary Document	Uploaded 2008-01-16	Available
Attachment C CDC IRB approval.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment B 60-day FRN.pdf	Supplementary Document	Uploaded 2008-01-16	Available
Attachment A Authorizing Legislation.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment G.5 FAQ for the DDI Patient Survey.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment G.4 Patient Consent.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment G.2 Stated Preferences Module.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment F.4 Thank you.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment F.2 Cover letter for DDI Health Clinic leadership survey.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment F.1 Advance -email message to clinic leadership survey.doc	Supplementary Document	Uploaded 2008-01-16	Available
Attachment F.3 1st and 2nd e-mail reminder messages for the clinic leadership survey.doc	Supplementary Document	Uploaded 2008-01-16	Available
Supporting Statement A.doc	Supporting Statement A	Uploaded 2008-01-16	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
183711	DDI Patient Survey	Form	New
183710	Screening Questions for the DDI Patient Survey	Form	New
183709	DDI Health Leadership Clinic Survey	Form	New

ICR Details

OMB Control No: 0920-0791	ICR Reference No: 200802-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: Assessing the Diabetes Detection Initiative for Policy Decisions
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/05/2008
	Date Received in OIRA: 02/06/2008
Terms of Clearance: Approved consistent with the following terms of clearance: OMB approves the proposed survey for purposes of gathering initial limited information regarding the diabetes detection pilot, upon completion of the survey CDC will provide OMB with a report detailing results, survey results will not be characterized as generalizable outside the survey areas/populations queried; additionally, given the limited scope of the pilot (10 sites) CDC will not rely solely or primarily on survey results generated from this collection to inform broader policy decisions related to diabetes.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	09/30/2009	12 Months From Approved
Responses	1,630	0	0
Time Burden (Hours)	263	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to conduct two related economic assessments of diabetes screening and outreach programs at clinics that participated in the Diabetes Detection Initiative, a national pilot program that was implemented at 10 locations across the United States. The results of the economic assessments will be critical for making a number of public health policy decisions related to screening for undiagnosed diabetes.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: Public Health Service 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:
	72 FR 8737	02/27/2007
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 3977	01/23/2008
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

table that charts list of burden

IC Title	Form No.	Form Name
DDI Health Leadership Clinic Survey	No number	DDI Health Leadership Clinic Survey
Screening Questions for the DDI Patient Survey	No number	DDI Patient Survey
DDI Patient Survey	No number	DDI Patient Survey

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ICR Summary of Burden

table that charts list 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	1,630	0	0	1,630	0	0
Annual Time Burden (Hours)	263	0	0	263	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a new data collection.

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Annual Cost to Federal Government: $176,628

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Uncollected

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? Uncollected

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? Uncollected

Is this ICR related to the Pandemic Response? Uncollected

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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: 02/06/2008

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