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Application for Recognition

CDC welcomes organizations that offer a lifestyle intervention to prevent type 2 diabetes to apply for recognition by the Diabetes Prevention Recognition Program (DPRP), a component of the National Diabetes Prevention Program. The DPRP can help to assure consistent delivery of program elements across participating sites and provides evaluation, monitoring, and technical assistance for your program. Any organization with the capacity to deliver a lifestyle intervention meeting the DPRP standards may apply for recognition.

Applying for Recognition

Before you apply, you should read theCDC Diabetes Prevention Recognition Program: Standards and Operating Procedures [PDF–498KB]. This document spells out the criteria for delivering lifestyle interventions that meet the standards for full recognition by CDC. The standards document also contains a capacity assessment—a list of six questions to ask about your organization’s readiness to participate in the national program. You are strongly encouraged to conduct this assessment. Answering those questions will help you decide if your organization has the resources to start and maintain a lifestyle  intervention that meets the requirements for full recognition.

To apply for recognition, complete the form on this page. After you submit the application form, you will receive a confirmation e-mail. This e-mail will include instructions for submitting an alternative curriculum, if applicable.

If you are using the CDC Diabetes Prevention Program Curriculum (CDC DPP Curriculum), CDC staff will notify you by e-mail of the outcome of your application within 15 working days. If you are using an alternative curriculum, CDC staff will review your alternative curriculum along with your application. In this case, CDC staff will notify you by e-mail of the outcome of your application within 30 working days of receiving your curriculum.

If you have any questions about your application or the recognition program, please send an email with the [subject] line “Diabetes Prevention Recognition Program Application” to DPRP.Ask@cdc.gov.

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Terms and Conditions of Use of Curricula Derived from the Original DPP  

Use of the CDC DPP Curriculum must be properly attributed and credited with the following copyright credit line: © 2012, University of Pittsburgh, based on the DPP research trial supported by cooperative agreement number U01-DK48489 from the U.S. Department of Health and Human Services, which has certain rights in the material.  

With proper attribution and credit the CDC DPP Curriculum, Plan Forward, Group Lifestyle Balance,™ as well as curricula specifically derived from the original DPP, may be used as follows without further permission or license from the University of Pittsburgh:

  1. Non-profit research and non-commercial education purposes;
  2. Charging a fee solely for cost recovery of materials and operations related to delivery of the curriculums listed directly above in this section (Section 3);
  3. Use of the curricula described directly above for the purpose of third- party reimbursement so long as no profit is made on this specific effort by the party delivering the lifestyle change intervention or administering these curricula as it is described above, for third- party reimbursement.   

Conditions in which usage of the CDC DPP Curriculum requires obtaining written permission and/or license from the University of Pittsburgh:             

  1. For-profit research or for-profit education activities; and
  2. Sale or use of the CDC DPP Curriculum for any commercial purpose other than as   described above.           

Use of the CDC DPP Curriculum for commercial purposes, other than as described above, is prohibited without the further written permission and/or license of the University of Pittsburgh. For further information on commercial use of the CDC DPP Curriculum, contact the University of Pittsburgh's Office of Technology Management at 412-648-2206.

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Diabetes Prevention Recognition Program (DPRP) Application Form

Form Approved
OMB No. 0920-0909
Exp. Date 11/30/2014

Public reporting burden of this collection of information is estimated to average 60 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden to CDC Reports Clearance Officer; 1600 Clifton Road NE, MS D-74, Atlanta, Georgia 30333; ATTN: PRA (0920-0909).

* Indicates Required field

GENERAL INFORMATION
1. Type of Application*
Select Initial if your organization has not previously applied for recognition; Change if there has been a change in your organization’s contact information; Re-applying if your organization lost recognition and you are re-applying for recognition.
 


2. Organization Code
 

This code is assigned by the DPRP. If you are applying for the first time, choose Not Applicable. If you selected Change or Re-applying in the box above, enter your previously assigned organization code in this box.

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Upon approval of your application, this will be published in the DPRP registry and on the program’s Web site.

4. Organization Physical Address (No P.O. Boxes)*
Upon approval of your application, this will be published in the DPRP registry and on the program’s Web site.

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5. Organization Mailing Address
 

Include if different from Organization Physical Address. DPRP staff will use this address to communicate by mail with your organization.





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Optional. Upon approval of your application, if provided, this will be published in the DPRP registry and on the program’s website.


7. Organization Phone Number*
This is the number that participants, payers, and others should call to obtain information about your program. Upon approval of your application, this will be published in the DPRP registry and on the program’s website.

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CONTACT INFORMATION
8. Contact Person Name*
The name of the individual who will be the applicant organization’s DPRP contact person. Salutation (e.g., Mr., Mrs., Dr., Ms., Miss, other [please specify]), last name, first name, middle initial, academic credentials (e.g., MD, RN, MPH, MPA, PhD, etc.). The contact person’s information will not be included in the registry.

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The contact person’s title within your organization (e.g., Lifestyle Program Coordinator).


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The contact person’s email address. DPRP staff will use this email address to communicate with your organization.


11. Contact Phone Number *
The contact person’s phone number. DPRP staff will use this number to communicate with your organization.

 

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12. Contact Fax Number
 

Optional. The contact person’s fax number. DPRP staff will use this number to communicate by fax with your organization.

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CURRICULUM INFORMATION (CHECK ONE)

13. Curriculum*
If you select Other Curriculum, you must send your alternative curriculum to DPRP upon submission of your application.


(must be submitted with application)

CERTIFICATION OF APPLICATION

Electronic signature: By submitting this application, your organization asserts that it has thoroughly reviewed the CDC Diabetes Prevention Recognition Program: Standards and Operating Procedures and would like to participate in the CDC’s voluntary recognition program. Your organization agrees to comply with all of the recognition criteria contained in the standards document, including the transmission of data to CDC every six months from the date of the initial lifestyle class for the purpose of program evaluation, continuing recognition and technical assistance.


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