Information Collection

African-American Women, Community Health Educators

IC 187933 under ICR 200806-0925-002 · OMB 0925-0486.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 African-American Women, Community Health Educators	Form and Instruction
1 instrument NIDDK_1301_05_Promoter Track Survey Instrument.doc	Form and Instruction
2 instrument NIDDK_1301_05_User_Track_Survey Instrument.doc	Form and Instruction
NIDDK_1301_05_User satisfaction survey OMB Generic Clearance Mini Supporting Statement.doc NIDDK_1301_05_User satisfaction survey OMB Generic Clearance Mini Supporting Statement	IC Document
NIDDK_1301_05_Generic Clearance Form.doc NIDDK_1301_05_Generic Clearance Form	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	instrument	NIDDK_1301_05_Promoter Track Survey Instrument.doc		Yes	Yes	Paper Only
Form and Instruction	2	instrument	NIDDK_1301_05_User_Track_Survey Instrument.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 115

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	115	0	0	0	0	0
Annual IC Time Burden (Hours)	10	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NIDDK_1301_05_User satisfaction survey OMB Generic Clearance Mini Supporting Statement	NIDDK_1301_05_User satisfaction survey OMB Generic Clearance Mini Supporting Statement.doc	01/16/2009
NIDDK_1301_05_Generic Clearance Form	NIDDK_1301_05_Generic Clearance Form.doc	01/16/2009

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