0920-0909 Evaluation Data Form

[NCCDPHP] CDC Diabetes Prevention Recognition Program (DPRP)

Att 4B Evaluation Data_OMB No. 0920-0909_09-27-23_final.xlsx

OMB: 0920-0909

Document [xlsx]
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ORGCODE PARTICIP COHORTID ENROLLMOT ENROLLHC PAYERSOURCE STATE PARTICIPZIP AGE AIAN ASIAN BLACK HISPANIC MENA NHPI WHITE ETHRACEINFO SEX GENDER HEIGHT EDU DIFFHEAR DIFFSEE DIFFMEM DIFFWALK DIFFDRESS DIFFERRAND



Form Approved































OMB No. 0920-0909































Exp. Date XX/XX/20XX































































































Public reporting burden of this collection of information is estimated to average 120 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8 Atlanta, Georgia 30333; ATTN: PRA (0920-0909)
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