PPOD Guide & Toolkit Survey (Private Sector)

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

Documents and Forms

Document Name Document Type
Form 0920-14VL PPOD Guide & Toolkit Survey (Private Sector) Form and Instruction
0920-14VL Attachment 3a PPOD Survey Screen Shots Attachment 3a PPOD Survey Screen Shots.docx Form and Instruction
Attachment 3b PPOD Survey Advance Email.doc Attachment 3b PPOD Survey Advance Email IC Document
Attachment 3c PPOD Reminder Email.docx Attachment 3c PPOD Reminder Email IC Document

Information Collection (IC) Details

IC Title:	PPOD Guide & Toolkit Survey (Private Sector)	Agency IC Tracking Number:	0920-14VL

Is this a Common Form? No		IC Status: New

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	0920-14VL	Attachment 3a PPOD Survey Screen Shots	Attachment 3a PPOD Survey Screen Shots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 80	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	80	80
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 3b PPOD Survey Advance Email	Attachment 3b PPOD Survey Advance Email.doc	10/22/2014
Attachment 3c PPOD Reminder Email	Attachment 3c PPOD Reminder Email.docx	10/22/2014

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