Formative and Summative Evaluation of the National Diabetes Prevention Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Spreadsheet for Grantees	Form	New	Available
Spreadsheet for Intervention Sites	Form	New	Available
Att 8b_Public Comments_08-20-15.docx	Supplementary Document	Uploaded 2015-09-03	Available
Att 8a_Federal Register Notice.pdf	Supplementary Document	Uploaded 2015-09-03	Available
Att 7_IRB Letter.pdf	Supplementary Document	Uploaded 2015-09-03	Available
Att 6_Thank you email_08-27-15.doc	Supplementary Document	Uploaded 2015-09-03	Available
Att 5_Reminder email_08-27-15.doc	Supplementary Document	Uploaded 2015-09-03	Available
Att 4_Invitation email_08-27-15.doc	Supplementary Document	Uploaded 2015-09-03	Available
Att 1b_PHSA.pdf	Supplementary Document	Uploaded 2015-09-03	Available
Att 1a_National DPP.pdf	Supplementary Document	Uploaded 2015-09-03	Available
Att 2_RE-AIM Framework_09-02-2015.docx	Supplementary Document	Uploaded 2015-09-03	Available
SS-B_0920-15ANC_09-02-2015.docx	Supporting Statement B	Uploaded 2015-09-03	Available
SS-A_0920-15ANC_09-02-2015.docx	Supporting Statement A	Uploaded 2015-09-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218088	Spreadsheet for Grantees	Form	New
218087	Spreadsheet for Intervention Sites	Form	New

ICR Details

OMB Control No: 0920-1090	ICR Reference No: 201509-0920-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 15ANC
Title: Formative and Summative Evaluation of the National Diabetes Prevention Program
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/15/2015
	Date Received in OIRA: 09/10/2015
Terms of Clearance: This collection is approved with the understanding that future study adjustments (e.g., modifications to sample sizes, inclusion of additional sites, etc.) will be submitted as nonsubstantive changes for small adjustments or revision requests for more substantial adjustments.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2018	36 Months From Approved
Responses	126	0	0
Time Burden (Hours)	162	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: CDC plans to collect information to assess strategies for promoting reach and sustainability of effective, community-based diabetes prevention lifestyle programs. Information will be collected from the 6 grantees funded through the National Diabetes Prevention Program, and the intervention sites that deliver the lifestyle change programs.

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Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
   PL: Pub.L. 111 - 148 1 Name of Law: National Diabetes Prevention Program
  

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:
	80 FR 32562	06/09/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 54286	09/09/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Spreadsheet for Intervention Sites	none	Spreadsheet for National DPP Intervention Sites
Spreadsheet for Grantees	none	Spreadsheet for NDPP Grantees

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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	126	0	0	126	0	0
Annual Time Burden (Hours)	162	0	0	162	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 for an existing collection without an OMB number.

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Annual Cost to Federal Government: $316,464

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]? Yes

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: 09/10/2015

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