Information Collection

DoD Virtual Diabetes Self-Management Education and Support (DoD DSMES) Patient Experience Feedback Survey

IC 277284 under ICR 202505-0704-008 · OMB 0704-0553.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
DoD Virtual DSMES Post Session Evaluation_5.13.2025.pdf	Other-Web Survey
0704-0553_One Pager_DOD DSMES Eval_5.20.2025.docx One Pager Justification	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Web Survey					Yes	Yes	Fillable Fileable

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 400

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	1,048	1,048

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
One Pager Justification		08/28/2025

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

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