Chronic Disease Self-Management Education Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
CDSME Participant Information Survey	Form and Instruction	Modified	Available
Program Information Cover Sheet	Form and Instruction	Modified	Available
Attendance Log	Form	Modified	Available
Chronic Disease Self-Management Education Program	Form	Modified	Repair queued
0036 Response to Public Comments 2022.docx	Supplementary Document	Uploaded 2022-11-29	Repair queued
0036 CDSME Supporting_ Final w PC.docx	Supporting Statement A	Uploaded 2022-11-29	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
206269	Chronic Disease Self-Management Education Program	Form and Instruction	Modified	CDSME Participant Information Survey
206269	Chronic Disease Self-Management Education Program	Form and Instruction	Modified	Program Information Cover Sheet
206269	Chronic Disease Self-Management Education Program	Form	Modified	Attendance Log
206269	Chronic Disease Self-Management Education Program	Form	Modified

ICR Details

OMB Control No: 0985-0036	ICR Reference No: 202211-0985-001
Status: Historical Active	Previous ICR Reference No: 201908-0985-003
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Chronic Disease Self-Management Education Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 01/03/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/01/2022
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2026	36 Months From Approved	12/31/2022
Responses	14,750	0	14,915
Time Burden (Hours)	3,534	0	3,375
Cost Burden (Dollars)	0	0	0

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Abstract: The Administration on Aging (AoA), part of the Administration for Community Living (ACL), will use the proposed set of data collection tools to monitor grantees receiving “Empowering Older Adults and Adults with Disabilities through Chronic Disease Self-Management Education (CDSME)” cooperative agreements.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Services Act
   PL: Pub.L. 109 - 365 202 Name of Law: functions of the Assistant Secretary for Aging
   PL: Pub.L. 111 - 148 4002 Name of Law: Prevention and Public Health Fund
   US Code: 42 USC 1701(a)(3)(A-B), (a)(4) Name of Law: Public Health Services Act
   US Code: 42 USC 1703(a)(4) Name of Law: Public Health Services Act
   US Code: 42 USC 300u-11 Name of Law: Patient Protection and Affordable Care Act
  

Citations for New Statutory Requirements: None

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

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 43041	07/19/2022
30-day Notice:	Federal Register Citation:	Citation Date:
	87 FR 72488	11/25/2022
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 1

table that charts list of burden

IC Title	Form No.	Form Name
Chronic Disease Self-Management Education Program	N/A, N/A, N/A	Attendance Log ,   Program Information Cover Sheet ,   CDSME Participant Information Survey

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	14,750	14,915	0	-165	0	0
Annual Time Burden (Hours)	3,534	3,375	0	159	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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: There is a program change increase of 159 annual burden hours and a decrease of -165 respondents. ACL intends to continue using an online data entry system for the program and participant survey data. In addition to non-substantive formatting edits, minor changes were made to the program information cover sheet and participant information survey. All changes proposed are based on feedback from a focus group that included a sub-set of current grantees, as well as consultation with subject matter experts. Changes to the collection activities include: • Program Information Cover Sheet: 1. Question #2: Added consent on behalf of the program facilitators to receive program updates/information from the National CDSME Resource Center. 2. Question #5: Additional evidence-based CDSME programs added to the list (reflective of approved programs included in the FY2019 Funding Opportunity Announcement). 3. Question #7: Information regarding funding source(s) requested to assess progress toward developing a sustainable program delivery infrastructure that is not solely reliant on ACL discretionary dollars. • Participant Information Survey: 1. Participant I.D. modified to reduce risk of personally identifiable information exposure. 2. Question #10: Added question regarding veteran status to further describe program participants, as well as to assist with partnerships with veteran-serving organizations. 3. Question #14: Anxiety Disorder and Depression are listed separately (vs. being combined). Also included Yes/No response options for each chronic condition listed to improve data analyses and reporting. 4. Question #15: Response options have been delineated as sub-bullets (vs. being grouped into a single item) to align with the American Community Survey. 5. Question #16: Added question regarding social isolation, a construct that has been demonstrated to have an association with health-related risks for older adults. This question will also be asked upon completion of the last program session. 6. Question #17: This question will be asked at baseline and upon completion of the last program session to measure change.

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Annual Cost to Federal Government: $249,299

Does this IC contain surveys, censuses, or employ statistical methods? No

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? No

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Common Form ICR:  No

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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: 12/01/2022

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