Information Collection

Spreadsheet for Intervention Sites

IC 218087 under ICR 201509-0920-001 · OMB 0920-1090.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1090 can be found here:

Documents and Forms

Document Name Document Type
Spreadsheet for Intervention Sites Form
Spreadsheet for National DPP Intervention Sites Att 3a_Spreadsheet for Sites_08-27-15.xlsx Form
Att 3c_Glossary of Terms_08-27-15.docx Glossary of Terms IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Spreadsheet for Intervention Sites	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	none	Spreadsheet for National DPP Intervention Sites	Att 3a_Spreadsheet for Sites_08-27-15.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 120	Number of Respondents for Small Entity: 5

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	120	120
Annual IC Time Burden (Hours)	90	90
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Glossary of Terms	Att 3c_Glossary of Terms_08-27-15.docx	09/03/2015

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