Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey Form and Instruction
1 MRRIN Pilot Project Survey 0925-0643_MRRIN Pilot Project Survey - Screenshots 4-10-15.docx Form and Instruction
0925-0643_Fast Track Template 2015_MRRIN Survey.doc Fast Track Submission Form IC Document
0925-0643_MRRIN Survey Consent Form (Word) 4-9-15.docx Consent Form IC Document

Information Collection (IC) Details

IC Title:	Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction 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
Form and Instruction	1	MRRIN Pilot Project Survey	0925-0643_MRRIN Pilot Project Survey - Screenshots 4-10-15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Submission Form	0925-0643_Fast Track Template 2015_MRRIN Survey.doc	04/10/2015
Consent Form	0925-0643_MRRIN Survey Consent Form (Word) 4-9-15.docx	04/10/2015

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