Information Collection

Chronic Disease Self-Management Education Program

IC 206270 under ICR 201303-0985-001 · OMB 0985-0036.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0036 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 5 Chronic Disease Self-Management Education Program	Form and Instruction
5 Semi-annual Performance Report and sample template Attachment O Semi-Annual Performance Report Directions and Sample Template.pdf	Form and Instruction
6 CDSME Sustainability Tool Attach Q CDSME Sustainability Tool 2-28-2013.pdf	Form and Instruction

IC Title:

Chronic Disease Self-Management Education Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	5	Semi-annual Performance Report and sample template	Attachment O Semi-Annual Performance Report Directions and Sample Template.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	6	CDSME Sustainability Tool	Attach Q CDSME Sustainability Tool 2-28-2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 66

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	440	440
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.