Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (OD/OER)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals Form and Instruction
1 Survey Screenshots 1b - Practice Transformation Web satisfaction survey screenshots.pdf Form and Instruction
1a - Practice Transformation Web satisfaction survey word version.docx Survey- Word Version IC Document
1c - Practice Transformation website informational screenshots.pdf Informational Screenshots IC Document
Fast-track template Request for Approval under the Generic Clearance for NDEP Practice Transformation.doc Fast-track Template Practice Transformation IC Document

Information Collection (IC) Details

IC Title:	Qualitative Service Delivery Feedback for National Diabetes Education Program (NDEP) through an Online Survey among Health Professionals	Agency IC Tracking Number:

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	1	Survey Screenshots	1b - Practice Transformation Web satisfaction survey screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,000	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,000	1,000
Annual IC Time Burden (Hours)	167	167
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Survey- Word Version	1a - Practice Transformation Web satisfaction survey word version.docx	07/08/2014
Informational Screenshots	1c - Practice Transformation website informational screenshots.pdf	07/08/2014
Fast-track Template Practice Transformation	Fast-track template Request for Approval under the Generic Clearance for NDEP Practice Transformation.doc	07/08/2014

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