Application data for public-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⚠️ Notice: This information collection may be referencing outdated material.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
Form 4a Application data for public-sector organizations Form and Instruction
4a 4a Revised Att 4a_revised_DPRP Application Page updates.pdf Form and Instruction
Application - public sector 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
Att 4b_revised_DPRP Home Page and Confirmation Email updates.pdf Att 4b_revised_DPRP Home Page and Confirmation Email updates IC Document

Information Collection (IC) Details

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

Is this a Common Form? No		IC Status: Modified

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 and Instruction	4a	4a Revised	Att 4a_revised_DPRP Application Page updates.pdf		Yes	Yes	Fillable Fileable
Form	none	Application - public sector	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: 12	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	12	12
Annual IC Time Burden (Hours)	12	12
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
Att 4b_revised_DPRP Home Page and Confirmation Email updates	Att 4b_revised_DPRP Home Page and Confirmation Email updates.pdf	03/07/2012

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