Formative and Summative Evaluation of the National Diabetes Prevention Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-1090 Delivery Sites Information	Form	Modified	Available
Form 0920-1090 Spreadsheet for Intervention Sites	Form	Modified	Available
PIA 1705 DREM Final.pdf	Supplementary Document	Uploaded 2019-04-23	Available
Att 8B ICF IRB Determination Final.pdf	Supplementary Document	Uploaded 2019-04-23	Available
Att 8A CDC Non-Research Determination Final.pdf	Supplementary Document	Uploaded 2019-04-23	Available
Att 7 1705 Evaluation Framework Final.xlsx	Supplementary Document	Uploaded 2019-04-23	Available
Att 6 Overview of Changes Final.doc	Supplementary Document	Uploaded 2019-04-23	Available
Att 5D Annual Assessment Rpt Dashboard FInal.docx	Supplementary Document	Uploaded 2019-04-23	Available
Att 5C Thank you Email Final.doc	Supplementary Document	Uploaded 2019-04-23	Available
Att 5B Reminder Email Final.doc	Supplementary Document	Uploaded 2019-04-23	Available
Att 5A Invitation Email Final.doc	Supplementary Document	Uploaded 2019-04-23	Available
Att 2A 60-Day FRN Final.pdf	Supplementary Document	Uploaded 2019-04-23	Available
Att 1B Authorizing Legislation for PHSA Final.pdf	Supplementary Document	Uploaded 2019-04-23	Available
Att 1A Authorizing Legislation for NDPP Final.pdf	Supplementary Document	Uploaded 2019-04-23	Available
0920 1090 SSB Final.docx	Supporting Statement B	Uploaded 2019-04-23	Available
0920 1090 SSA Final.docx	Supporting Statement A	Uploaded 2019-04-23	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
218088	Delivery Sites Information	Form	Modified
218087	Spreadsheet for Intervention Sites	Form	Modified

ICR Details

OMB Control No: 0920-1090	ICR Reference No: 201902-0920-010
Status: Historical Inactive	Previous ICR Reference No: 201509-0920-001
Agency/Subagency: HHS/CDC	Agency Tracking No: 15ANC
Title: Formative and Summative Evaluation of the National Diabetes Prevention Program
Type of Information Collection: Reinstatement without change of a previously approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Improperly submitted	Conclusion Date: 05/28/2019
	Date Received in OIRA: 04/24/2019
Terms of Clearance: CDC will resubmit as a reinstatement with change

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date		36 Months From Approved
Responses	0	0	0
Time Burden (Hours)	0	0	0
Cost Burden (Dollars)	0	0	0

---

Abstract: CDC's Division of Diabetes Translation's Revision of the Information Collection Request (OMB No. 0920-1090, exp.12/31/2018) supporting an evaluation of the National Diabetes Prevention Program: Research has shown that an evidence-based lifestyle change program leading to weight loss and increased physical activity prevent or delay type 2 diabetes in persons with prediabetes or those at high risk of developing type 2 diabetes. The Public Health Service Act gives CDC general authority to evaluate programs and translate research findings into practice.

---

Authorizing Statute(s): US Code: 42 USC 241 Name of Law: PHSA
   PL: Pub.L. 111 - 148 1 Name of Law: National Diabetes Prevention Program
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	83 FR 50098	10/04/2018
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 10091	03/19/2019
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 2

table that charts list of burden

IC Title	Form No.	Form Name
Spreadsheet for Intervention Sites	0920-1090	National Grantee Information
Delivery Sites Information	0920-1090	Delivery sites Information

---

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: A number of changes to the forms and increased burden estimates are proposed to address public comments and ensure that evaluation requirements are consistent with the new coop. agreement.

---

Annual Cost to Federal Government: $162,606

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 04/24/2019

---