Delivery Sites Information

Formative and Summative Evaluation of the National Diabetes Prevention Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1090 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1090 Delivery Sites Information Form
0920-1090 Delivery sites Information Att 3B 1705 Evaluation Form for Sites Final.xlsx Form
Att 3C Glossary of Terms Final.docx Glossary of Terms IC Document

Information Collection (IC) Details

IC Title:	Delivery Sites Information	Agency IC Tracking Number:	0920-1090

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	0920-1090	Delivery sites Information	Att 3B 1705 Evaluation Form for Sites Final.xlsx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	600	600
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Glossary of Terms	Att 3C Glossary of Terms Final.docx	04/23/2019

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