Introductory Session Landscape Assessment

National Diabetes Prevention Program Introductory Session Project

Documents and Forms

Document Name Document Type
Form 0920-19BOI Introductory Session Landscape Assessment Form and Instruction
19BOI Att 1h Programmed Landscape Ass Survey Orgs Final.pdf Other-programmed view
19BOI Att 1i. Programmed Landscape Ass Survey Class Locs Final.pdf Other-programmed view
0920-19BOI Introductory Session Landscape Assessment 19BOI Att 1aa Intro Session Survey Class Locations Final.docx Form and Instruction
0920-19BOI Pre Session Survey 19BOI Att 2 Pre Session Survey Final.docx Form and Instruction
0920-19BOI Post- Session Survey 19BOI Att 3 Post-Session Survey Final.docx Form and Instruction
0920-19BOI BYB Discovery Session Implementation Fidelity Checklist 19BOI Att 5 BYB Implem Fidelity Chklst Final.xlsx Form and Instruction
0920-19BOI REGISTRATION AND ATTENDANCE TRACKING FORM 19BOI Att 4 Registration & Attendance Form Final.xlsm Form and Instruction
19BOI Att 1 Organizations Final.docx Introductory Session Landscape Assessment IC Document

Information Collection (IC) Details

IC Title:	Introductory Session Landscape Assessment	Agency IC Tracking Number:	0920-19BOI

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	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	0920-19BOI	Introductory Session Landscape Assessment	19BOI Att 1aa Intro Session Survey Class Locations Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	Pre Session Survey	19BOI Att 2 Pre Session Survey Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	Post- Session Survey	19BOI Att 3 Post-Session Survey Final.docx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	BYB Discovery Session Implementation Fidelity Checklist	19BOI Att 5 BYB Implem Fidelity Chklst Final.xlsx	Yes	Yes	Fillable Fileable
Form and Instruction	0920-19BOI	REGISTRATION AND ATTENDANCE TRACKING FORM	19BOI Att 4 Registration & Attendance Form Final.xlsm	Yes	Yes	Fillable Fileable
Other-programmed view			19BOI Att 1h Programmed Landscape Ass Survey Orgs Final.pdf	Yes	Yes	Fillable Fileable
Other-programmed view			19BOI Att 1i. Programmed Landscape Ass Survey Class Locs Final.pdf	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 5,478	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions, Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	5,478	5,478
Annual IC Time Burden (Hours)	1,572	1,572
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Introductory Session Landscape Assessment	19BOI Att 1 Organizations Final.docx	02/11/2020

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.