Information Collection

Semi-annual Report for Diabetes Prevention and Control Programs

IC 178772 under ICR 201003-0920-011 · OMB 0920-0479.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 2 Semi-annual Report for Diabetes Prevention and Control Programs	Form
2 Semi-Annual Report for Diabetes Prevention and Control P Attachment 4. MIS Semi-Annual Report Tabs.ppt	Form
Attachment 5. Technical Appendix.pdf Attachment 5	IC Document
Attachment 6. MIS Services and Tools.ppt Attachment 6	IC Document

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	2	Semi-Annual Report for Diabetes Prevention and Control Programs	Attachment 4. MIS Semi-Annual Report Tabs.ppt		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

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	Previously Approved
Annual Number of Responses for this IC	106	47	59
Annual IC Time Burden (Hours)	1,749	864	885
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 5	Attachment 5. Technical Appendix.pdf	02/25/2010
Attachment 6	Attachment 6. MIS Services and Tools.ppt	02/25/2010

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