Information Collection

Adults

IC 7476 under ICR 201408-0925-005 · OMB 0925-0552.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Adults	Form and Instruction
1 NDEP Survey Screenshots Att B-2 Screen shots of NDEP National Diabetes Survey Instrument--English.pdf	Form and Instruction
Att B-3 Screen shots of NDEP National Diabetes Survey Instrument--Spanish.pdf NDEP Spanish Survey Screenshots	IC Document
Att E GfK's E-mail Notification to KP Participant for NNDS 25Aug2014.pdf Email Notification	IC Document

IC Title:

Adults

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

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	NDEP Survey Screenshots	Att B-2 Screen shots of NDEP National Diabetes Survey Instrument--English.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 2,500

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	2,500	-1,259	3,759
Annual IC Time Burden (Hours)	833	708	125
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NDEP Spanish Survey Screenshots	Att B-3 Screen shots of NDEP National Diabetes Survey Instrument--Spanish.pdf	08/25/2014
Email Notification	Att E GfK's E-mail Notification to KP Participant for NNDS 25Aug2014.pdf	08/25/2014

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.