Information Collection

GenIC Testing of Spanish-language Messages for the National Diabetes

IC 222786 under ICR 201502-0920-001 · OMB 0920-0572.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0572 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Appendix 1. Screener.docx	Other-WORD
HMTS Supplement 063016.docx HMTS Supplement Document	IC Document
HMTS Expedited Review Form-National DPP Spanish-language message testing 062416.pdf HMTS Expedited Review Request	IC Document
Appendix 2. English-Spanish Messages.docx App 2_ English-Spanish Messages	IC Document
Appendix 3 in-person consumer FGs 063016.pdf App 3_In-person Consumer FGs	IC Document
Appendix 4 on-line consumer FGs 063016.pdf App 4_On-line Consure FGs	IC Document
Appendix 5 family member in-person FGs 063016.pdf App 5_Family Member In-person FG	IC Document

IC Title:

GenIC Testing of Spanish-language Messages for the National Diabetes

Agency IC Tracking Number:

16AWH

IC Status: New

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
Other-WORD			Appendix 1. Screener.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 90

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 6 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	180	180
Annual IC Time Burden (Hours)	158	158
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HMTS Supplement Document	HMTS Supplement 063016.docx	08/02/2016
HMTS Expedited Review Request	HMTS Expedited Review Form-National DPP Spanish-language message testing 062416.pdf	08/02/2016
App 2_ English-Spanish Messages	Appendix 2. English-Spanish Messages.docx	08/02/2016
App 3_In-person Consumer FGs	Appendix 3 in-person consumer FGs 063016.pdf	08/02/2016
App 4_On-line Consure FGs	Appendix 4 on-line consumer FGs 063016.pdf	08/02/2016
App 5_Family Member In-person FG	Appendix 5 family member in-person FGs 063016.pdf	08/02/2016

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