View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Chronic Disease Self-Management Education Program	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	N/A	Attendance Log	0036 Attendance Log.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	Program Information Cover Sheet	0036 Program Information_Cover Sheet_ 2022.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	N/A	CDSME Participant Information Survey	0036 CDSME-Participant-Information Survey- 2022.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Community and Social Services

Subfunction: Social Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 14,750	Number of Respondents for Small Entity: 0

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

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	14,750	0	-165	0	0	14,915
Annual IC Time Burden (Hours)	3,534	0	159	0	0	3,375
Annual IC Cost Burden (Dollars)	0	0	0	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.