Diabetes Primary Prevention

NCHS Questionnaire Design Research Laboratory

OMB: 0920-0222

IC ID: 214369

Information Collection (IC) Details

View Information Collection (IC)

Diabetes Primary Prevention 15IS
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form none Questionnaire Attach 1 Diabetes Qnne 121914.docx No   Paper Only
Form none Screener Attach 3a &3b screener 121914.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

117 0
   
Individuals or Households
 
   100 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 117 0 117 0 0 0
Annual IC Time Burden (Hours) 51 0 51 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Flyer Attach 2 Diabetes AdFlyer 121914.docx 12/19/2014
Informed Consent Attach 4 Diabetes Informed Consent 121914.docx 12/19/2014
Diabetes 10 Day Letter 0920-0222 QDRL Diabetes 10day ltr 120414.docx 12/19/2014
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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