Information Collection

Survey of State-based Diabetes Prevention and Control Programs

IC 191479 under ICR 200912-0920-001 · OMB 0920-0839.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Survey of State-based Diabetes Prevention and Control Programs	Form and Instruction
2 Survey of State-based Diabetes Prevention and Control Pr Attachment D Partner Survey.doc	Form and Instruction
Attachment D2 Partner Reminder.doc Attachment D2 Partner Reminder	IC Document
Attachment D1 Partner Invitation.doc Attachment D1 Partner Invitation	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	2	Survey of State-based Diabetes Prevention and Control Programs	Attachment D Partner Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment D2 Partner Reminder	Attachment D2 Partner Reminder.doc	11/12/2009
Attachment D1 Partner Invitation	Attachment D1 Partner Invitation.doc	11/12/2009

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