Chronic Disease Self-Management Education Program

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0985-0036 can be found here:

Documents and Forms

Document Name Document Type
Form 5 Chronic Disease Self-Management Education Program Form and Instruction
5 Semi-annual Performance Report and sample template Attachment O Semi-Annual Performance Report Directions and Sample Template.pdf Form and Instruction
6 CDSME Sustainability Tool Attach Q CDSME Sustainability Tool 2-28-2013.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Chronic Disease Self-Management Education Program	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	5	Semi-annual Performance Report and sample template	Attachment O Semi-Annual Performance Report Directions and Sample Template.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	6	CDSME Sustainability Tool	Attach Q CDSME Sustainability Tool 2-28-2013.pdf		Yes	Yes	Fillable Fileable

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 66	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 Agency Discretion
Annual Number of Responses for this IC	66	66
Annual IC Time Burden (Hours)	440	440
Annual IC Cost Burden (Dollars)	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.