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Participant Follow-up Interview
COMMUNITY EVALUATION OF THE NATIONAL DIABETES EDUCATION PROGRAMS DIABETES HEALTHSENSE WEBSITE
OMB: 0925-0694
IC ID: 210069
OMB.report
HHS/NIH
OMB 0925-0694
ICR 201401-0925-005
IC 210069
( )
Documents and Forms
Document Name
Document Type
Form 4
Participant Follow-up Interview
Form and Instruction
4 Participant Follow-Up Interview
3D - NDEP DHS Participant Follow-Up Interview Guide_110613_OMB30.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Participant Follow-up Interview
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Voluntary
CFR Citation:
Information Collection Instruments:
Document Type
Form No.
Form Name
Instrument File
URL
Available Electronically?
Can Be Submitted Electronically?
Electronic Capability
Form and Instruction
4
Participant Follow-Up Interview
3D - NDEP DHS Participant Follow-Up Interview Guide_110613_OMB30.docx
No
No
Paper Only
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
10
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
Approved
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
10
0
10
0
0
0
Annual IC Time Burden (Hours)
10
0
10
0
0
0
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
No associated records found
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.