Evaluation data for private-sector organizations

CDC Diabetes Prevention Recognition Program (DPRP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0909 can be found here:

Documents and Forms

Document Name Document Type
Evaluation data for private-sector organizations Form and Instruction
Evaluation Data Attachment 5A Evaluation Data Elements (2014).docx Form and Instruction
Attachment 5B Evaluation Data Elements (2011).docx Data Dictionary approved 2011 IC Document
Attachment 5C Evaluation Data Submission Web Application (screenshot).docx DPRP Data Web Application IC Document

Information Collection (IC) Details

IC Title:	Evaluation data for private-sector organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	none	Evaluation Data	Attachment 5A Evaluation Data Elements (2014).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 720	Number of Respondents for Small Entity: 540

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	720	288	432
Annual IC Time Burden (Hours)	720	288	432
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Data Dictionary approved 2011	Attachment 5B Evaluation Data Elements (2011).docx	09/25/2014
DPRP Data Web Application	Attachment 5C Evaluation Data Submission Web Application (screenshot).docx	09/25/2014

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