Retrospective Data Collection

Using Traditional Foods and Sustainable Ecological Approaches for Health Promotion and Diabetes Prevention in American Indian/Alaska Native Communities

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0889 can be found here:

Documents and Forms

Document Name Document Type
Retrospective Data Collection Form
Shared data elements - screen shots Att 4a. Traditional Foods SDEs 03222011.pdf Form
Att 4b. Partner Notification-Shared Data Elements.doc Att 4b - Partner notification data elements IC Document
Att 4c. Email with Link to SDE.doc Att 4c - Email with SDE link IC Document

Information Collection (IC) Details

IC Title:	Retrospective Data Collection	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Shared data elements - screen shots	Att 4a. Traditional Foods SDEs 03222011.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 6	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	6	6
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4b - Partner notification data elements	Att 4b. Partner Notification-Shared Data Elements.doc	03/23/2011
Att 4c - Email with SDE link	Att 4c. Email with Link to SDE.doc	03/23/2011

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