National Diabetes Education Program Evaluation Survey of the Public

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Screening Interview with Ineligible Persons	Form and Instruction	Modified	Available
Form 1 Eligible Respondents	Form and Instruction	Modified	Available
NDEP Public Survey OMB SUPPORTING STATEMENT B 22Aug2012 FINAL.doc	Supporting Statement B	Uploaded 2012-08-29	Available
NDEP Public Survey OMB SUPPORTING STATEMENT A rev 22Aug2012 FINAL.doc	Supporting Statement A	Uploaded 2012-08-29	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
7476	Screening Interview with Ineligible Persons	Form and Instruction	Modified
187314	Eligible Respondents	Form and Instruction	Modified

ICR Details

OMB Control No: 0925-0552	ICR Reference No: 201208-0925-004
Status: Historical Active	Previous ICR Reference No: 200811-0925-002
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: National Diabetes Education Program Evaluation Survey of the Public
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 10/15/2012
	Date Received in OIRA: 08/29/2012
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2015	36 Months From Approved
Responses	5,859	0	0
Time Burden (Hours)	650	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The National Diabetes Education Program (NDEP) is a partnership of the National Institutes of Health (NIH) and the Centers for Disease Control and Prevention (CDC) and more than 200 public and private organizations. The long?term goal of the NDEP is to reduce the burden of diabetes and pre-diabetes in the United States, and its territories, by facilitating the adoption of proven strategies to prevent or delay the onset of diabetes and its complications. The program audiences include the public, people at risk for diabetes, people with diabetes and their families, with special emphasis on racial/ethnic populations; health care providers; and payers and purchasers of health care and health care system policy makers.

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Authorizing Statute(s): US Code: 42 USC 285c Name of Law: Diabetes Mellitus Interagency Coordinating Committee
  

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
60-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 3783	01/25/2012
30-day Notice:	Federal Register Citation:	Citation Date:
	77 FR 38072	06/26/2012
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Screening Interview with Ineligible Persons	1	Survey Screener
Eligible Respondents	1	NDEP Questionnaire

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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	5,859	0	0	5,859	0	0
Annual Time Burden (Hours)	650	0	0	650	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: This is a request for a reinstatement without change.

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Annual Cost to Federal Government: $250,000

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? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

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: 08/29/2012

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