View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	DoD Virtual Diabetes Self-Management Education and Support (DoD DSMES) Patient Experience Feedback Survey	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
Other-Web Survey			DoD Virtual DSMES Post Session Evaluation_5.13.2025.pdf		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Defense and National Security

Subfunction: Operational Defense

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 95 %

	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	400	0	400	0	0	0
Annual IC Time Burden (Hours)	33	0	33	0	0	0
Annual IC Cost Burden (Dollars)	1,048	0	1,048	0	0	0

Documents for IC

Title	Document	Date Uploaded
One Pager Justification	0704-0553_One Pager_DOD DSMES Eval_5.20.2025.docx	08/28/2025

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