Medicine: Mind the Gap NIH Seminar Series Survey-For Profits

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⚠️ Notice: This information collection may be referencing outdated material.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 Medicine: Mind the Gap NIH Seminar Series Survey-For Profits Form and Instruction
1 Customer Satisfaction Survey 2015 MtG Customer Satisfaction Survey - Survey Monkey Screenshot.docx Form and Instruction
Fast Track Template FP - Mind the Gap Evaluation_11 09 15.doc Fast Track Submission Form -For profit IC Document

Information Collection (IC) Details

IC Title:	Medicine: Mind the Gap NIH Seminar Series Survey-For Profits	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	Customer Satisfaction Survey	2015 MtG Customer Satisfaction Survey - Survey Monkey Screenshot.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast Track Submission Form -For profit	Fast Track Template FP - Mind the Gap Evaluation_11 09 15.doc	11/12/2015

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