4 Organization Site Types

OMB Control No. 0985-XXXX
Exp. Date XX/XX/201

2012 Chronic Disease Self-Management Education Grant Program
List of Organization Site Types
Table 1: CDSME Organization Site Type Options

Organization Types
Area Agency on Aging
County Health Department
Educational Institution
Library
Parks and Recreation/Other Recreational
Organization
Tribal Center
Health Care Organization
Faith-Based Organization
Senior Center
Workplace
Other Community Center
Residential Facility

Examples

School, community college, university,
extension program, etc.
Other: YMCA, Jewish Community Center, etc.

Hospital, community health center, adult day
health center, etc.
Church, synagogue, etc.
Included Councils on Aging
Any location where program is provided to
employees
Multi-purpose social services organization,
youth center, nutrition site, etc.
Assisted or independent living, senior housing,
etc.

Other
Unknown or Not Provided

PAPERWORK REDUCTION ACT STATEMENT
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection
is 0985-xxx. The time required to complete this information collection is estimated to average 15 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and
complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: Administration for Community Living, 1
Massachusetts Avenue, N.W., Room 5203, Washington, D.C. 20001, Attention: PRA Reports Clearance Officer