Chronic Disease Self-Management Education Program

Chronic Disease Self-Management Education Program

OMB: 0985-0036

IC ID: 206269

Information Collection (IC) Details

View Information Collection (IC)

Chronic Disease Self-Management Education Program
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction NA Program Information Cover Sheet 0036 Program.Info.Cover.Sheet.Revised.2.docx Yes Yes Fillable Fileable
Form and Instruction NA Participant Information Survey 0036 CDSME Participant Survey - Revised Sheet v3.docx Yes Yes Fillable Fileable
Form and Instruction NA Attendance Log 0036 CDSME.Attendance.Log.Revised.1.docx Yes Yes Fillable Fileable

Community and Social Services Social Services

 

14,915 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  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 14,915 0 0 10,283 0 4,632
Annual IC Time Burden (Hours) 3,375 0 2,789 0 0 586
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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

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