Information Collection

National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys

IC 231398 under ICR 201605-0920-001 · OMB 0920-1050.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 0920-1050 National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys	Form and Instruction
0920-1050 National DDP Customer Service Center -- Surveys Along th Att 5. - National DPP Customer Service Center - Surveys.pptx	Form and Instruction
Att 1. - Fast_Track_Cust Sat_National DPP CSC.DOCX Request for Approval	IC Document
Att 3. - Supporting-Statement-Part_A_National DPP CSC Customer Satisfaction.docx Supporting Statement A	IC Document
Att 4. - Supporting-Statement-Part_B_National DPP CSC Customer Satisfaction.docx Supporting Statement B	IC Document
Att 6. - 684 Form.pdf IRB Approval	IC Document

IC Title:

National Diabetes Prevention Program Customer Service Center (National DPP CSC) -- Customer Satisfactory Surveys

Agency IC Tracking Number:

0920-1050 (18AFG)

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
Form and Instruction	0920-1050	National DDP Customer Service Center -- Surveys Along the Customer Journey	Att 5. - National DPP Customer Service Center - Surveys.pptx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 3,000

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

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

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	3,000	3,000
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Request for Approval	Att 1. - Fast_Track_Cust Sat_National DPP CSC.DOCX	05/09/2018
Supporting Statement A	Att 3. - Supporting-Statement-Part_A_National DPP CSC Customer Satisfaction.docx	05/09/2018
Supporting Statement B	Att 4. - Supporting-Statement-Part_B_National DPP CSC Customer Satisfaction.docx	05/09/2018
IRB Approval	Att 6. - 684 Form.pdf	05/09/2018

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