[NCCDPHP] Formative Evaluation, Implementation and Rapid Evaluation (FIRE) of Diabetes Self-Management in Disproportionately Affected Populations (DAPs) Provider Listening Sessions (Phase I)

[OS] CDC/ATSDR Formative Research and Tool Development

OMB: 0920-1154

IC ID: 260016

Documents and Forms
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Document Type
Form and Instruction
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Form and Instruction
IC Document
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Information Collection (IC) Details

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[NCCDPHP] Formative Evaluation, Implementation and Rapid Evaluation (FIRE) of Diabetes Self-Management in Disproportionately Affected Populations (DAPs) Provider Listening Sessions (Phase I) 0920-1154-22HG
 
Unchanged
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction None DSMES Provider Screener Script and Guidelines 1154 Att A FIRE Listening Sessions_DSMES Provider Screener_.docx Yes Yes Fillable Fileable
Form and Instruction None Listening Sessions Guide for Providers Who Support People with Learning Disabilities 1154 Att B FIRE Listening Session Guide PLD.docx Yes Yes Fillable Fileable
Form and Instruction None Listening Sessions Guide for Providers Who Support Minority Women 1154 Att C FIRE Listening Session Guide MW.docx Yes Yes Fillable Fileable
Form and Instruction None Listening Sessions Guide for Providers Who Support People with Mental Health Disorders 1154 Att D FIRE Listening Session Guide PWMHD.docx Yes Yes Fillable Fileable

Health Illness Prevention

 

150 0
   
Private Sector Businesses or other for-profits, Not-for-profit institutions
 
   100 %

  Requested 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 150 0 0 0 0 150
Annual IC Time Burden (Hours) 68 0 0 0 0 68
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Supporting Statement Part A 1154 SSA DDT_revised.docx 05/04/2023
Supporting Statement Part B 1154 SSB DDT.docx 05/02/2023
Recruitment Emails 1154 Att E FIRE Recruitment Emails.docx 05/02/2023
FHI360 Determination: IRB Approval is Not Required 1154 Att F IRB Determination notice.pdf 05/02/2023
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.

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