Information Collection

Diabetes Prevention and Control Program

IC 194059 under ICR 201310-0920-001 · OMB 0920-0870.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0870 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Diabetes Prevention and Control Program	Form
1 Management Information System (MIS) screen shots Att 4. NCCDPHP MIS Screen Shots.docx	Form

IC Title:

Diabetes Prevention and Control Program

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

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	1	Management Information System (MIS) screen shots	Att 4. NCCDPHP MIS Screen Shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 53

Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Change Due to Adjustment in Agency Estimate	Previously Approved
Annual Number of Responses for this IC	-106	106
Annual IC Time Burden (Hours)	-636	636
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.