View Information Collection (IC)
View Information Collection (IC)

View Information Collection (IC)

Message Testing for Diabetes Self-Management Education and Support (DSMES) Branding: Cart Sort Activity 0920-0572-20AA
 
New
 
Voluntary
 

Document Type Form No. Form Name Instrument File URL Available Electronically? Can Be Submitted Electronically? Electronic Capability
Form and Instruction 0920-0572 Screener Diabetes Educators File 3 Card Sort Screeners Diabetes Educators 2 .docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Screener Health Care Providers File 4 Card Sort Screeners Health care providers 2.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Screener People with DM File 5 Card Sort Screeners People with DM 2.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Diabetes Educators Survey File 7 -CARD SORT instrument Word Diabetes educators.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Health Care Providers Survey File 8 -CARD SORT instrument Word Health care providers.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Person with DM had DSMES Survey File 9 - CARD SORT instrument Word Person with DM Had DSMES.docx Yes Yes Fillable Fileable
Form and Instruction 0920-0572 Person with DM not had DSMES Survey File 10 - CARD SORT instrument Word Person with DM Not Had DSMES.docx Yes Yes Fillable Fileable

Health Public Health Monitoring

 

1,400 0
   
Individuals or Households
 
   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 1,400 0 1,400 0 0 0
Annual IC Time Burden (Hours) 150 0 150 0 0 0
Annual IC Cost Burden (Dollars) 0 0 0 0 0 0

Title Document Date Uploaded
Expedited Review Form File 1 - HMTSExpeditedReviewForm for card sort.pdf 10/07/2019
Expedited Review Supplement File 2 HMTS Expedited Review Supplement - DSMES Card Sort 2.docx 10/09/2019
Informed Consent Screenshots File 6 -Card Sort Informed Consent Screenshots.docx 10/07/2019
Diabetes Educators Survey Screenshots File 11 - Card Sort Instrument Screenshots_Diabetes Educators.docx 10/07/2019
Healthcare Providers Survey Screenshot File 12 - Card Sort Instrument Screenshots_Health Care Providers.docx 10/07/2019
Person with DM had DSMES Screenshot File 13 - Card Sort Instrument Screenshots_Person with DM Had DSMES.docx 10/07/2019
Person with DM no DSMES Screenshot File 14 - Card Sort Instrument Screenshots_Person with DM Not Had DSMES.docx 10/07/2019
            Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.