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Recipient-Led Evaluation Reporting
National Evaluation of the DP18-1815 Cooperative Agreement Program: Category A, Diabetes Management and Type 2 Diabetes Prevention
OMB: 0920-1312
IC ID: 241400
OMB.report
HHS/CDC
OMB 0920-1312
ICR 201910-0920-009
IC 241400
( )
Documents and Forms
Document Name
Document Type
Recipient-Led Evaluation Reporting
Form and Instruction
Category A Recipient-Led Annual Evaluation Report
Att 5b. 1815 Cat A Eval Report Tool_30Day.docx
Form and Instruction
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Recipient-Led Evaluation Reporting
Agency IC Tracking Number:
Is this a Common Form?
No
IC Status:
New
Obligation to Respond:
Required to Obtain or Retain Benefits
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
n/a
Category A Recipient-Led Annual Evaluation Report
Att 5b. 1815 Cat A Eval Report Tool_30Day.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Public Health Monitoring
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
51
Number of Respondents for Small Entity:
0
Affected Public:
State, Local, and Tribal Governments
Percentage of Respondents Reporting Electronically:
100 %
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
51
0
51
0
0
0
Annual IC Time Burden (Hours)
408
0
408
0
0
0
Annual IC Cost Burden (Dollars)
17,952
0
17,952
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.