Application data for private-sector organizations

CDC Diabetes Prevention Recognition Program (DPRP)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-0909 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-0909 Application data for private-sector organizations Form and Instruction
0920-0909 DPRP Application Form Att 4A DPRP Application Form and Instructions (screenshots).docx Form and Instruction
Attachment 4B_ DPRP Web Site (screenshot).docx Home Page IC Document
Attachment 4C Application Confirmation Pages (screenshots).docx DPRP Confirmation Email IC Document
Attachment 4D Application Received Confirm Email.docx DPRP Confirmation Email IC Document
Attachment 4E Application Accepted Notice.docx DPRP Application Acceptance Email IC Document
Attachment 4F Application Rejected Notice.docx DPRP Application Rejection Email IC Document

Information Collection (IC) Details

IC Title:	Application data for private-sector organizations	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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 and Instruction	0920-0909	DPRP Application Form	Att 4A DPRP Application Form and Instructions (screenshots).docx	NA	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 350	Number of Respondents for Small Entity: 158

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	Previously Approved
Annual Number of Responses for this IC	350	140	210
Annual IC Time Burden (Hours)	350	140	210
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
Home Page	Attachment 4B_ DPRP Web Site (screenshot).docx	09/18/2014
DPRP Confirmation Email	Attachment 4C Application Confirmation Pages (screenshots).docx	09/25/2014
DPRP Confirmation Email	Attachment 4D Application Received Confirm Email.docx	09/25/2014
DPRP Application Acceptance Email	Attachment 4E Application Accepted Notice.docx	09/25/2014
DPRP Application Rejection Email	Attachment 4F Application Rejected Notice.docx	09/25/2014

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