DDI Health Leadership Clinic Survey

Assessing the Diabetes Detection Initiative for Policy Decisions

Documents and Forms

Document Name Document Type
Form No number DDI Health Leadership Clinic Survey Form
No number DDI Health Leadership Clinic Survey Attachment F DDI Health Clinic Leadership Survey.doc Form
Attachment F.3 1st and 2nd e-mail reminder messages for the clinic leadership survey.doc Attachment F IC Document
Attachment F.1 Advance -email message to clinic leadership survey.doc Attachment F IC Document
Attachment F.2 Cover letter for DDI Health Clinic leadership survey.doc Attachment F IC Document
Attachment F.4 Thank you.doc Attachment F IC Document

Information Collection (IC) Details

IC Title:	DDI Health Leadership Clinic Survey	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	No number	DDI Health Leadership Clinic Survey	Attachment F DDI Health Clinic Leadership Survey.doc		Yes	No	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 30

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	30	30
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment F	Attachment F.3 1st and 2nd e-mail reminder messages for the clinic leadership survey.doc	01/16/2008
Attachment F	Attachment F.1 Advance -email message to clinic leadership survey.doc	01/16/2008
Attachment F	Attachment F.2 Cover letter for DDI Health Clinic leadership survey.doc	01/16/2008
Attachment F	Attachment F.4 Thank you.doc	01/16/2008

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.