New Beginnings Assessment 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
New Beginnings Assessment Survey (Private Sector) Form and Instruction
Attachment 4a New Beginnings Survey Screenshots Attachment 4a- NBWeb Survey Screenshots_031615.docx Form and Instruction
Attachment 4b NB Survey Advance Email.docx Attachment 4b NB Survey Advance Email IC Document
Attachment 4c NB Reminder Email.docx Attachment 4c NB Reminder Email IC Document

Information Collection (IC) Details

IC Title:	New Beginnings Assessment Survey (Private Sector)	Agency IC Tracking Number:

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	None	Attachment 4a New Beginnings Survey Screenshots	Attachment 4a- NBWeb Survey Screenshots_031615.docx	None	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 700	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	700	700
Annual IC Time Burden (Hours)	175	175
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 4b NB Survey Advance Email	Attachment 4b NB Survey Advance Email.docx	10/22/2014
Attachment 4c NB Reminder Email	Attachment 4c NB Reminder Email.docx	10/22/2014

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