Community Health Maps Project User Survey

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Community Health Maps Project User Survey Form and Instruction
1 Survey Screenshots NLM CHMP Survey Instrument (SurveyMonkey screen shots).pdf Form and Instruction
NIH fast track_generic_clearance_request_NLM CHMP survey.doc Fast Track Template IC Document

Information Collection (IC) Details

IC Title:	Community Health Maps Project User 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	Survey Screenshots	NLM CHMP Survey Instrument (SurveyMonkey screen shots).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 100	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	100	100
Annual IC Time Burden (Hours)	17	17
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Template	NIH fast track_generic_clearance_request_NLM CHMP survey.doc	03/10/2015

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