Information Collection

Eligible Respondents

IC 187314 under ICR 201408-0925-005 · OMB 0925-0552.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NDEP Questionnaire Eligible Respondents	Form and Instruction
1 NDEP Questionnaire Att A NDEP Natl Diab Survey Final Annotated Questionnaire for OMB 22Aug2012 FINAL.doc	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Removed

Obligation to Respond: Voluntary

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	1				Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,100

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	-2,100	2,100
Annual IC Time Burden (Hours)	-525	525
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.

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