Information Collection

Diabetes Diagnosis Form

IC 201684 under ICR 201808-0420-004 · OMB 0420-0550.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form PC-262-3 Diabetes Diagnosis Form	Form and Instruction
PC-262-3 Diabetes Evaluation Form Diabetes_Eval.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

PC-262-3

IC Status: Unchanged

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	PC-262-3	Diabetes Evaluation Form	Diabetes_Eval.docx		Yes	No	Fillable Printable

Line of Business: International Affairs and Commerce

Subfunction: International Development and Humanitarian Aid

Privacy Act System of Records

Title: Diabetes Evaluation Form

FR Citation: 70 FR 1

Number of Respondents: 55

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	55	55
Annual IC Time Burden (Hours)	28	28
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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