OMB.report

Federal forms, ICRs, and supporting documents

Information Collection

Reaching Minority Men Where They Are – Formative Research to Build Capacity for Enrollment in Diabetes Prevention and Management Programs

IC 236556 under ICR 201610-0920-009 · OMB 0920-1154.

Documents and Forms
Document Name
Document Type
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Reaching Minority Men Where They Are – Formative Research to Build Capacity for Enrollment in Diabetes Prevention and Management Programs 0920-19BHN
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction n/a Focus Group Guide: Minority Men at Risk for Type 2 Diabetes RMM Att 2 FocusGroupGuideAtRisk FINAL (7.1.2019).docx No   Paper Only
Form and Instruction n/a Focus Group Guide: Minority Men Diagnosed with Type 2 Diabetes RMM Att 3 FocusGroupGuideWithDiabetes FINAL (7.1.2019).docx No   Paper Only
Form and Instruction n/a Screener RMM Att 4 FocusGroupScreener FINAL (7.1.2019).docx No   Paper Only
Form and Instruction n/a Initial Screen Shot of the Web-based Survey (with OMB control information) RMM Att 10 Survey Intro Screenshot FINAL.docx Yes Yes Fillable Fileable
Form and Instruction n/a Survey (content) RMM Att 5 Survey Questionnaire Minority Male FINAL (7.1.2019).docx Yes Yes Fillable Fileable

Health Illness Prevention

 

4,048 0
   
Individuals or Households
 
   98 %

  Approved Program Change Due to New Statute Program Change Due to Agency Discretion Change Due to Adjustment in Agency Estimate Change Due to Potential Violation of the PRA Previously Approved
Annual Number of Responses for this IC 4,048 0 4,048 0 0 0
Annual IC Time Burden (Hours) 447 0 447 0 0 0
Annual IC Cost Burden (Dollars) 10,877 0 10,877 0 0 0

Title Document Date Uploaded
Authorizing Legislation: Public Health Service Act RMM Att 1 PHSA Final.pdf 07/01/2019
IRB Approval RMM Att 6 IRB Approval FINAL.pdf 07/01/2019
Survey Consent RMM Att 7 Survey Consent FINAL.docx 07/01/2019
Focus Group Consent RMM Att 8 Participant Consent Form FINAL (7.1.2019).docx 07/01/2019
Example Table Shells (how data will be analyzed) RMM Att 9 Example Stub & Banner Table Shell FINAL.xlsx 07/01/2019
Supporting Statement Part A RMM SSA FINAL (7.2.2019).docx 07/02/2019
Supporting Statement Part B RMM SSB FINAL (7.1.2019).docx 07/02/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.