Information Collection

Chronic Disease Self-management Workshop Evaluation

IC 234802 under ICR 201901-0920-012 · OMB 0920-1265.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1265 can be found here:

Documents and Forms

Document Name Document Type
Chronic Disease Self-management Workshop Evaluation Form
Workshop Evaluation Att. 4 Chronic Disease Self-Management Workshop Evaluation.docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Chronic Disease Self-management Workshop Evaluation	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: New

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	none	Workshop Evaluation	Att. 4 Chronic Disease Self-Management Workshop Evaluation.docx		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 190	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	190	190
Annual IC Time Burden (Hours)	32	32
Annual IC Cost Burden (Dollars)	190	190

Documents for IC

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.