Information Collection

Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals

IC 212287 under ICR 201112-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals	Form and Instruction
1 Survey Screenshots 1b - Practice Transformation Web satisfaction survey screenshots.pdf	Form and Instruction
1a - Practice Transformation Web satisfaction survey word version.docx Survey- Word Version	IC Document
1c - Practice Transformation website informational screenshots.pdf Informational Screenshots	IC Document
Fast-track template Request for Approval under the Generic Clearance for NDEP Practice Transformation.doc Fast-track Template Practice Transformation	IC Document

IC Title:

Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals

Agency IC Tracking Number:

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	1	Survey Screenshots	1b - Practice Transformation Web satisfaction survey screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,000

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Survey- Word Version	1a - Practice Transformation Web satisfaction survey word version.docx	07/08/2014
Informational Screenshots	1c - Practice Transformation website informational screenshots.pdf	07/08/2014
Fast-track Template Practice Transformation	Fast-track template Request for Approval under the Generic Clearance for NDEP Practice Transformation.doc	07/08/2014

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