OMB control number

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

OMB 0920-1265 · HHS/CDC.

OMB 0920-1265

This collection is to evaluate the first implementation of Stanford University's Chronic Disease Self-Management Program in the US Affiliated Pacific Islands. The evaluation will assess program participation satisfaction with the program and participants' overall health and health behaviors before and after the program.The purpose of this evaluation is to look at the fidelity of the program to ensure it is meeting Stanford’s standards for implementation and to know if this program can be effective for people in the USAPIs to better manage their chronic conditions.

The latest form for [NCCDPHP] Evaluation of the Chronic Disease Self-Management Program in the US Affiliated Pacific Islands expires 2026-04-30 and is listed under ICR 202208-0920-001.

View the official OMB control history on Reginfo.gov.

Latest Forms, Documents, and Supporting Material

Latest forms, documents, and information collections
Document	Type
Form 0920-1265 Chronic Disease Self-management Questionnaire	Form and Instruction
Form 0920-1265 Chronic Disease Self-management Workshop Evaluation	Form and Instruction
1265 PN.pdf	Supplementary Document
1265 Att 8 Privacy Impact Assesment.pdf	Supplementary Document
1265 Att 7 IRB Approval.pdf	Supplementary Document
1265 Att 6 Participants in Consultation Outside the Agency.docx	Supplementary Document
1265 Att 5 CDSMP Evaluation Consent Form.docx	Supplementary Document
1265 Att 3 Data Coll & Data Flow Process.docx	Supplementary Document
1265 Att 1 Authorizing Legislation.pdf	Supplementary Document
Att. 8 Privacy Impact Assesment.pdf	Supplementary Document
Att. 7_Institutional Review Board Approval Notification or exemption determination.pdf	Supplementary Document
Att. 6 Participants in Consultation Outside the Agency.docx	Supplementary Document
Att. 5 CDSMP Evaluation Consent Form.docx	Supplementary Document
Att. 3_Data Collection and Data Flow Process.docx	Supplementary Document
Att. 2 60 Day Federal Register Notice.pdf	Supplementary Document
Att. 1 Authorizing Legislation Section 301(a) of the Public Health Service Act [42.U.S.C. 242K].pdf	Supplementary Document
1265 SSB.docx	Supporting Statement B
1265 SSA.docx	Supporting Statement A
Chronic Disease Self-management Questionnaire	Form and Instruction
Chronic Disease Self-management Workshop Evaluation	Form and Instruction

All Historical Document Collections

Historical document collections
Reference	Filing	Received	Concluded	Action
202208-0920-001	Reinstatement without change of a previously approved collection	2023-01-25		Approved without change
201901-0920-012	New collection (Request for a new OMB Control Number)	2019-02-15		Approved with change

OMB Details

Chronic Disease Self-management Workshop Evaluation

Federal Enterprise Architecture: Health - Public Health Monitoring

Information collection instruments
Form	Name	Electronic access	Type
Form 0920-1265	Att 4 CDSMP Workshop Evaluation	Fillable Fileable	Form and instruction

Review document collections for all forms, instructions, and supporting documents - including paper/printable forms.