National Diabetes Education Program Evaluation Survey of the Public

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Screening Interview with Ineligible Persons	Form and Instruction	Modified	Available
Form 1 Eligible Respondents	Form and Instruction	New	Available
Attachment A Questionnaire 1-09 doc.doc	Supplementary Document	Uploaded 2009-01-07	Available
Supporting Statement Part B (3).doc	Supporting Statement B	Uploaded 2008-11-14	Available
Attachment B Evaluation Work Group.doc	Supplementary Document	Uploaded 2008-11-14	Available
Attachment C 2006 Survey Report.doc	Supplementary Document	Uploaded 2008-11-14	Available
Revised Supporting Statement Part A doc 1-09.doc	Supporting Statement A	Uploaded 2009-01-07	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7476	Screening Interview with Ineligible Persons	Form and Instruction	Modified
187314	Eligible Respondents	Form and Instruction	New

ICR Details

OMB Control No: 0925-0552	ICR Reference No: 200811-0925-002
Status: Historical Active	Previous ICR Reference No: 200507-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: National Diabetes Education Program Evaluation Survey of the Public
Type of Information Collection: Extension without change of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 01/08/2009
	Date Received in OIRA: 11/25/2008
Terms of Clearance: Approved per revised Supporting Statement A and Questionnaire uploaded into ROCIS on 01/07/09.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved	01/31/2009
Responses	3,759	0	1
Time Burden (Hours)	575	0	400
Cost Burden (Dollars)	0	0	0

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Abstract: This is a request for OMB approval of clearance to conduct a nationwide survey of the public related to the objectives of the National Diabetes Education Program.

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Authorizing Statute(s): US Code: 42 USC 285c Name of Law: Diabetes Mellitus Interagency Coordinating Committee
  

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:
	73 FR 52052	09/08/2008
30-day Notice:	Federal Register Citation:	Citation Date:
	73 FR 71012	11/24/2008
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Screening Interview with Ineligible Persons	1	questionnaire
Eligible Respondents	1	questionnaire

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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	3,759	1	0	0	3,758	0
Annual Time Burden (Hours)	575	400	0	0	175	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $250,000

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: 11/25/2008

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