OMB.report

Federal forms, ICRs, and supporting documents

Information Collection Request

National Evaluation of the DP18-1815 Cooperative Agreement Program: Category A, Diabetes Management and Type 2 Diabetes Prevention

ICR 201910-0920-009 · OMB 0920-1312 · Active

Forms and Documents
DocumentTypeStatusAvailability
National DPP Lifestyle Coach Interview Form and Instruction New Repair queued
National DPP Program Coordinator Interview Form and Instruction New Available
National DPP Partner Site-Level Rapid Evaluation Survey Form and Instruction New Available
DSMES Paraprofessional Team Member Interview Form and Instruction New Available
DSMES Professional Team Member Interview Form and Instruction New Repair queued
DSMES Program Coordinator Interview Form and Instruction New Repair queued
DSMES Partner Site-Level Rapid Evaluation Survey Form and Instruction New Available
National DPP Partner Site-Level Rapid Evaluation Nomination Form and Instruction New Repair queued
DSMES Partner Site-Level Rapid Evaluation Nomination Form and Instruction New Available
Recipient-Led Evaluation Reporting Form and Instruction New Available
Evaluation and Performance Measurement Plan (EPMP) Form and Instruction New Available
Att 8d. Cat A Site Rapid Eval Fnl Rem Comm.docx Supplementary Document Uploaded 2020-05-04 Repair queued
Att 8c. Cat A Site Rapid Eval Survey Rem Comm.docx Supplementary Document Uploaded 2020-05-04 Repair queued
Att 8b. Cat A Site Rapid Eval Invit Comm.docx Supplementary Document Uploaded 2020-05-04 Available
Att 8a. Cat A Site Rapid Eval Pre Survey Comm_v02.docx Supplementary Document Uploaded 2020-12-02 Available
Att 7a. Inst Rev Brd App Det Pt B.pdf Supplementary Document Uploaded 2020-05-04 Available
Att 7a. Inst Rev Brd App Det Pt A.pdf Supplementary Document Uploaded 2020-05-04 Available
Att 6. 60-day FRN.pdf Supplementary Document Uploaded 2020-05-04 Available
Att 3f. Cat A 1815 Eval Gantt Chart.xlsx Supplementary Document Uploaded 2020-05-04 Available
Att 3e. Cat A 1815 Summ of Annual Resp_v06.docx Supplementary Document Uploaded 2020-05-04 Repair queued
Att 3d. Cat A Crosswalk of Eval Comp_Data Coll.Tool.docx Supplementary Document Uploaded 2020-05-04 Available
Att 3c. 1815 Logic Model.docx Supplementary Document Uploaded 2020-05-04 Available
Att 3b.1815 Strat Prev_Control .docx Supplementary Document Uploaded 2020-05-04 Available
Att 3a. 1815 List of HD Awardees.docx Supplementary Document Uploaded 2020-05-04 Available
Att 2. Auth Leg Sec 301a of the PH Serv Act.pdf Supplementary Document Uploaded 2020-05-04 Available
Att 1. CDC-RFA-DP18-1815PPHF18.pdf Supplementary Document Uploaded 2020-05-04 Available
SSB_1815 Category A_v09.docx Supporting Statement B Uploaded 2020-12-02 Available
SSA_1815 Category A_v09.docx Supporting Statement A Uploaded 2020-12-02 Repair queued
IC Document Collections
IC IDCollectionTypeStatusForm
241410 National DPP Lifestyle Coach Interview Form and Instruction New
241409 National DPP Program Coordinator Interview Form and Instruction New
241408 National DPP Partner Site-Level Rapid Evaluation Survey Form and Instruction New
241407 DSMES Paraprofessional Team Member Interview Form and Instruction New
241405 DSMES Professional Team Member Interview Form and Instruction New
241404 DSMES Program Coordinator Interview Form and Instruction New
241403 DSMES Partner Site-Level Rapid Evaluation Survey Form and Instruction New
241402 National DPP Partner Site-Level Rapid Evaluation Nomination Form and Instruction New
241401 DSMES Partner Site-Level Rapid Evaluation Nomination Form and Instruction New
241400 Recipient-Led Evaluation Reporting Form and Instruction New
241399 Evaluation and Performance Measurement Plan (EPMP) Form and Instruction New
ICR Details
0920-1312 201910-0920-009
Active
HHS/CDC 0920-19BHC
National Evaluation of the DP18-1815 Cooperative Agreement Program: Category A, Diabetes Management and Type 2 Diabetes Prevention
New collection (Request for a new OMB Control Number)   No
Regular
Approved with change 12/03/2020
Retrieve Notice of Action (NOA) 05/15/2020
  Inventory as of this Action Requested Previously Approved
12/31/2023 36 Months From Approved
894 0 0
1,084 0 0
39,230 0 0
The cooperative agreement supports state investments in implementing and evaluating evidence-based strategies to prevent and manage diabetes and cardiovascular disease (CVD). This information collection request focuses on activities conducted under Category A of the cooperative agreement: Diabetes Management and Type 2 Diabetes Prevention, The purpose of data collection is to evaluate how states are using funds and determine how those efforts are contributing to state, health system, or other organization level changes/outcomes related to diabetes.
US Code: 42 USC 241 Name of Law: Public Health Service Act
  
None
Not associated with rulemaking
  84 FR 32185 07/05/2019
85 FR 29457 05/15/2020
No
  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 894 0 0 894 0 0
Annual Time Burden (Hours) 1,084 0 0 1,084 0 0
Annual Cost Burden (Dollars) 39,230 0 0 39,230 0 0
Yes
Miscellaneous Actions
No
This is a new information collection.
$1,333,819
No
    Yes
    No
No
No
No
No
Renita Macaluso 770 488-6458 [email protected]
  No
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:
 
 
 
 
 
 
 
    (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;
 
 
 
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.
05/15/2020