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Federal forms, ICRs, and supporting documents

Information Collection

Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support

IC 242658 under ICR 201806-0920-001 · OMB 0920-0572.

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
Form and Instruction
Form and Instruction
Form and Instruction
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
IC Document
Information Collection (IC) Details

View Information Collection (IC)

Brand Concept Testing for Diabetes Self-Management Education and Support (DSMES) Services Marketing Support 0920-0572-20PB
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 PWD Screener Online Survey 2b--DSMES Brand Concept Testing_PWD Screener Survey_for OMB.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 PWD Online Survey 2c--DSMES Brand Concept Testing PWD Survey_for OMB.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 HCP Screener In Depth Interview 3a--DSMES Brand Concept Testing_HCP Screener IDI for OMB.docx No   Fillable Fileable
Form and Instruction 0920-0572 HCP In Depth Interview Guide 3b--DSMES Brand Concept Testing - IDI Guide- for OMB.docx No   Fillable Fileable
Form and Instruction 0920-0572 HCP Screener Online Survey 4b--DSMES Brand Concept Testing_HCP Screener Survey for OMB rev.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 HCP Online Survey 4c--DSMES Brand Concept Testing HCP Survey for OMB.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 PWD Focus Group Moderators Guide 1c--DSMES Brand Concept Testing - FG Moderators Guide for OMB.docx No   Fillable Fileable
Form and Instruction 0920-0572 PWD Screener for Focus Groups 1b--DSMES Brand Concept Testing_PWD Screener Focus Groups_for OMB.docx No   Fillable Fileable

Health Public Health Monitoring

 

3,144 0
   
Individuals or Households
 
   80 %

  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 3,144 0 3,144 0 0 0
Annual IC Time Burden (Hours) 477 0 477 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
PWD Consent for Focus Groups 1a--DSMES Brand Concept Testing Informed Consent_Focus Groups PWD_for OMB.docx 07/10/2020
PWD Consent for Online Survey 2a--DSMES Brand Concept Testing Informed Consent_Survey PWD_for OMB.docx 07/10/2020
PWD Screenshots for Online Survey 2d-- Brand Concept Testing- PWD Screenshots for OMB .docx 07/16/2020
HCP Consent for Online Survey 4a--DSMES Brand Concept Testing Informed Consent_Survey HCP_for OMB.docx 07/10/2020
HCP Online Survey Screenshots 4d-Brand Concept Testing- HCP Screenshots for OMB.docx 07/10/2020
Attachment with Samples OMB supplementatl attachment with samples of concepts.docx 07/10/2020
Expedited Review Form HMTSExpeditedReviewForm_DSMESConcept Testing june222020rev.pdf 07/10/2020
Supplemental Information HMTS Expedited Review Supplement-DSMES Brand Cpt Testing for OMB revised re OMB and ICRO comments.docx 07/10/2020
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.