Chronic Disease Self-Management Education Program

Forms and Documents

Document Name	Status
Form 5 Chronic Disease Self-Management Education Program Form and Instruction	Removed
Chronic Disease Self-Management Education Program Form and Instruction	Modified
0036 CDSME Supporting Statement 2019.docx Supporting Statement A	2019-10-29

IC Document Collections

IC ID	Document Title	Status
206270	Chronic Disease Self-Management Education Program Form and Instruction	Removed
206269	Chronic Disease Self-Management Education Program Form and Instruction	Modified

ICR Details

OMB Control No: 0985-0036	ICR Reference No: 201908-0985-003
Status: Active	Previous ICR Reference No: 201606-0985-002
Agency/Subagency: HHS/ACL	Agency Tracking No:
Title: Chronic Disease Self-Management Education Program
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 11/26/2019
	Date Received in OIRA: 10/30/2019
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2022	36 Months From Approved	11/30/2019
Responses	14,915	0	4,648
Time Burden (Hours)	3,375	0	693
Cost Burden (Dollars)	0	0	0

---

Abstract: The Administration on Aging (AoA), part of the Administration for Community Living (ACL), will use the proposed set of data collection tools to monitor grantees receiving “Empowering Older Adults and Adults with Disabilities through Chronic Disease Self-Management Education (CDSME)” cooperative agreements. Most recently, through funding provided by 2019 Prevention and Public Health Funds, ACL awarded 11 cooperative agreements for a three-year project period beginning May 1, 2019. Grantee agencies represent a variety of organization types, including state agencies (aging and public health), area agencies on aging, universities, and nonprofit organizations. Grantees are tasked with two primary goals: (1) significantly increase the number of older adults and adults with disabilities who participate in CDSME and self-management support programs and (2) develop a sustainable infrastructure for these proven interventions. The most widely disseminated CDSME is the Chronic Disease Self-Management Program (CDSMP), originally developed at Stanford University. In addition to the English version of the CDSMP, which is appropriate for any type of chronic condition, other evidence-based self-management education programs have been developed for individuals with diabetes, chronic pain, or HIV, those with cancer or cancer survivors, for Spanish-speaking individuals, and in an internet format. Additionally, self-management support programs spanning topics such as behavioral health, physical activity, and medication management are supported through this funding initiative. Grantees collect information at both the workshop and participant level. Specific to the workshop, information on workshop type, location, start/end date, etc. is collected. At the participant level, de-identified demographic and health status information is collected. AoA funds the National Council on Aging (NCOA) to serve as the National CDSME Resource Center and provide technical assistance (TA) to grantees as well as the broader network of organizations implementing CDSME and self-management support programs. NCOA created an online database that grantees and other program sites use to provide data on their workshops. This system allows AoA to regularly monitor grantee performance status, including data analysis, maps, comparative charts, and identification of high- and low-performing grantees in order to identify and target technical assistance needs. AoA will use this set of data collection tools to monitor 29 grantees that were awarded cooperative agreements in response to the “Empowering Older Adults and Adults with Disabilities through Chronic Disease Self-Management Education Programs” funding opportunities competed in 2017, 2018, and 2019. These data collection tools will also be used for future CDSME cooperative agreements. AoA will use the information to: 1) comply with reporting requirements mandated by the authorizing statutes; 2) collect data for performance measures used in the justification of the budget to Congress and by program, state, and national decision makers; 3) effectively manage the CDSME program at the federal, state, and local levels; 4) identify program implementation issues and technical assistance needs; 5) identify best practices to serve as the basis for developing resources to help grantees learn from and replicate these practices; and 6) provide information for reports to Congress, other government agencies, stakeholders, and to the public about grantee progress. Data will be collected from grantee staff and program staff/volunteers involved in delivering CDSME workshops, as well as individuals who participate in CDSME workshops

---

Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Services Act
   PL: Pub.L. 109 - 365 202 Name of Law: functions of the Assistant Secretary for Aging
   PL: Pub.L. 111 - 148 4002 Name of Law: Prevention and Public Health Fund
   PL: Pub.L. 112 - 74 220 Name of Law: Reporting
   US Code: 42 USC 1701(a)(3)(A-B), (a)(4) Name of Law: Public Health Services Act
   US Code: 42 USC 1703(a)(4) Name of Law: Public Health Services Act
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 32746	07/09/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 56813	10/23/2019
Did the Agency receive public comments on this ICR? Yes

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Chronic Disease Self-Management Education Program	NA, NA, NA	Program Information Cover Sheet ,   Participant Information Survey ,   Attendance Log
Chronic Disease Self-Management Education Program	5	CDSME Progress Report Instructions

---

ICR Summary of Burden

	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	14,915	4,648	0	0	10,267	0
Annual Time Burden (Hours)	3,375	693	0	2,789	-107	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: There is an adjustment increase of 10,283 respondents and a program change increase of 2,789 annual burden hours. ACL is not requesting renewal of Host/Implementation Organization Information Form or performance report instructions. ACL intends to continue using an online data entry system for the program and participant survey data. In addition to non-substantive formatting edits, minor changes were made to the program information cover sheet and participant information survey. All changes proposed are based on feedback from a focus group that included a sub-set of current grantees, as well as consultation with subject matter experts.

---

Annual Cost to Federal Government: $238,326

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? Yes

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  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:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(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;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

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.

Certification Date: 10/30/2019

---