Chronic Disease Self-management Questionnaire

[NCCDPHP] Evaluation of the Chronic Disease Self-Management Program in the US Affiliated Pacific Islands

OMB: 0920-1265

IC ID: 234803

Information Collection (IC) Details

View Information Collection (IC)

Chronic Disease Self-management Questionnaire 0920-1265
 
No Modified
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-1265 1265 Att 4(a) CDSMP Questionnaire 1265 Att 4(a) CDSMP Questionnaire.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

190 0
   
Individuals or Households
 
   0 %

  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 380 0 380 0 0 0
Annual IC Time Burden (Hours) 63 0 63 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

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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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