CDC Diabetes Prevention Recognition Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Evaluation data for private-sector organizations	Form and Instruction	Modified	Available
Evaluation data for public-sector organizations	Form and Instruction	Modified	Available
Application data for private-sector organizations	Form	Modified	Available
Form 4a Application data for public-sector organizations	Form and Instruction	Modified	Available
OMBChangesTable_12302011.docx	Supplementary Document	Uploaded 2012-03-07	Available
OMB change request memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2012-03-07	Repair queued
Attachment 5C - Ongoing Evaluation Data Reminder_11 22 2011.docx	Supplementary Document	Uploaded 2011-11-28	Available
Attachment 5B - Evaluation Data Reminder (07.29.11).docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 5C - Ongoing Evaluation Data Reminder_11 22 2011.docx	Supplementary Document	Uploaded 2011-11-28	Available
Attachment 5B - Evaluation Data Reminder (07.29.11).docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4F - Application Rejection (07.29.11).docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4E - Application Acceptance (07.29.11).docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4D - Application Confirmation Email.docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4C - DPRP Application Confirmation Page.pptx	Supplementary Document	Uploaded 2011-09-01	Repair queued
Attachment 4B - DPRP homepage (07.29.11).pptx	Supplementary Document	Uploaded 2011-09-01	Repair queued
Att 4b_revised_DPRP Home Page and Confirmation Email updates.pdf	Supplementary Document	Uploaded 2012-03-07	Available
Attachment 4F - Application Rejection (07.29.11).docx	Supplementary Document	Uploaded 2011-09-01	Repair queued
Attachment 4E - Application Acceptance (07.29.11).docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4D - Application Confirmation Email.docx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4C - DPRP Application Confirmation Page.pptx	Supplementary Document	Uploaded 2011-09-01	Available
Attachment 4B - DPRP homepage (07.29.11).pptx	Supplementary Document	Uploaded 2011-09-01	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
199192	Evaluation data for private-sector organizations	Form and Instruction	Modified
199191	Evaluation data for public-sector organizations	Form and Instruction	Modified
199190	Application data for private-sector organizations	Form	Modified
199189	Application data for public-sector organizations	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0909	ICR Reference No: 201203-0920-003
Status: Historical Active	Previous ICR Reference No: 201109-0920-002
Agency/Subagency: HHS/CDC	Agency Tracking No:
Title: CDC Diabetes Prevention Recognition Program
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/08/2012
	Date Received in OIRA: 03/08/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2014	11/30/2014	11/30/2014
Responses	600	0	600
Time Burden (Hours)	600	0	600
Cost Burden (Dollars)	0	0	0

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Abstract: The Patient Protection and Affordable Care Act directed CDC to establish a national diabetes prevention program. Community-based organizations may apply to CDC for recognition of their programs. Information will be collected to monitor, evaluate and provide technical assistance to these organizations.

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Authorizing Statute(s): PL: Pub.L. 111 - 148 399-V Name of Law: Patient Protection and Affordable Care Act
   US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments

Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
Application data for public-sector organizations	4a, none	4a Revised ,   Application - public sector
Application data for private-sector organizations	none	Att 4a - Application page
Evaluation data for public-sector organizations	none	Att 5a - Evaluation data elements
Evaluation data for private-sector organizations	none	Att 5a - Evaluation data elements

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	600	600	0	0	0	0
Annual Time Burden (Hours)	600	600	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $1,011,510

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/08/2012

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