Application data for private-sector organizations

CDC Diabetes Prevention Recognition Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0909 can be found here:

Documents and Forms

Document Name Document Type
Application data for private-sector organizations Form
Att 4a - Application page Attachment 4A - DPRP application page (07.29.11).pptx Form
Attachment 4B - DPRP homepage (07.29.11).pptx Att 4b - DPRP homepage IC Document
Attachment 4C - DPRP Application Confirmation Page.pptx Att 4c - Application confirmation page IC Document
Attachment 4D - Application Confirmation Email.docx Att 4d - Application confirmation email IC Document
Attachment 4E - Application Acceptance (07.29.11).docx Att 4e - Application acceptance IC Document
Attachment 4F - Application Rejection (07.29.11).docx Att 4f - Application rejection IC Document

Information Collection (IC) Details

IC Title:	Application data for private-sector organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	none	Att 4a - Application page	Attachment 4A - DPRP application page (07.29.11).pptx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 108	Number of Respondents for Small Entity: 18

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	108	108
Annual IC Time Burden (Hours)	108	108
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Att 4b - DPRP homepage	Attachment 4B - DPRP homepage (07.29.11).pptx	09/01/2011
Att 4c - Application confirmation page	Attachment 4C - DPRP Application Confirmation Page.pptx	09/01/2011
Att 4d - Application confirmation email	Attachment 4D - Application Confirmation Email.docx	09/01/2011
Att 4e - Application acceptance	Attachment 4E - Application Acceptance (07.29.11).docx	09/01/2011
Att 4f - Application rejection	Attachment 4F - Application Rejection (07.29.11).docx	09/01/2011

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