Screening Interview with Ineligible Persons

National Diabetes Education Program Evaluation Survey of the Public

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0552 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Screening Interview with Ineligible Persons Form and Instruction
1 Questionaire Att A NDEP Natl Diab Survey Final Annotated Questionnaire 2012_forOMB.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	Screening Interview with Ineligible Persons	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	1	Questionaire	Att A NDEP Natl Diab Survey Final Annotated Questionnaire 2012_forOMB.pdf		Yes	Yes	Printable Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,659	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,659	1,659
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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