Assessing the Adoption and Utility of National Diabetes Education Program (NDEP) Tools and Resources for Health Care Professionals and Health Education Facilitators

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-14VL PPOD Guide & Toolkit Survey (Federal Government Sector)	Form and Instruction	New	Available
New Beginnings Assessment Survey (State/Local Government Sector)	Form and Instruction	New	Available
Form 0920-14VL PPOD Guide & Toolkit Survey (State and Local Government Sector)	Form and Instruction	New	Available
New Beginnings Assessment Survey (Private Sector)	Form and Instruction	New	Available
Form 0920-14VL PPOD Guide & Toolkit Survey (Private Sector)	Form and Instruction	New	Available
Attachment 2 60day FRN 4 30 2014.pdf	Supplementary Document	Uploaded 2014-11-12	Available
Attachment 1 Public Health Service Act.doc	Supplementary Document	Uploaded 2014-11-12	Available
Attachment 5 IRB Approval.pdf	Supplementary Document	Uploaded 2014-10-22	Available
Supporting Statement B_3 11 2015.docx	Supporting Statement B	Uploaded 2015-03-18	Available
Supporting Statement A_3 11 2015.docx	Supporting Statement A	Uploaded 2015-03-18	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
213589	PPOD Guide & Toolkit Survey (Federal Government Sector)	Form and Instruction	New
213588	New Beginnings Assessment Survey (State/Local Government Sector)	Form and Instruction	New
213585	PPOD Guide & Toolkit Survey (State and Local Government Sector)	Form and Instruction	New
213582	New Beginnings Assessment Survey (Private Sector)	Form and Instruction	New
213579	PPOD Guide & Toolkit Survey (Private Sector)	Form and Instruction	New

ICR Details

OMB Control No: 0920-1055	ICR Reference No: 201410-0920-026
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-14VL
Title: Assessing the Adoption and Utility of National Diabetes Education Program (NDEP) Tools and Resources for Health Care Professionals and Health Education Facilitators
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 03/20/2015
	Date Received in OIRA: 11/12/2014
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2016	12 Months From Approved
Responses	1,000	0	0
Time Burden (Hours)	233	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC will collect information to assess use of, and audience satisfaction with, diabetes education resources. Target audiences are health educators and primary health care providers who serve patients with diabetes, with emphasis on the medical specialties of pharmacy, podiatry, optometry, and dentistry.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 24438	04/30/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 63124	10/22/2014
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
New Beginnings Assessment Survey (Private Sector)	None	Attachment 4a New Beginnings Survey Screenshots
PPOD Guide & Toolkit Survey (State and Local Government Sector)	0920-14VL	Attachment 3a PPOD Survey Screen Shots
PPOD Guide & Toolkit Survey (Federal Government Sector)	0920-14VL	Attachment 3a PPOD Survey Screen Shots
New Beginnings Assessment Survey (State/Local Government Sector)	None	Attachment 4a New Beginnings Survey Screenshots
PPOD Guide & Toolkit Survey (Private Sector)	0920-14VL	Attachment 3a PPOD Survey Screen Shots

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	1,000	0	0	1,000	0	0
Annual Time Burden (Hours)	233	0	0	233	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: This is a new ICR request.

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Annual Cost to Federal Government: $219,903

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 11/10/2014

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