The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A

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⚠️ Notice: This information collection may be referencing outdated material.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 The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A Form and Instruction
LRP Applicant Survey Form A - Invitation Email.docx Other-email
1 LRP Survey for Applicants Form A- Screenshots LRP Survey for Applicants Form A - Screenshots.pdf Form and Instruction
LRP Applicant Survey Form A - PCB Fasttrack Template.doc The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A IC Document

Information Collection (IC) Details

IC Title:	The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A	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	LRP Survey for Applicants Form A- Screenshots	LRP Survey for Applicants Form A - Screenshots.pdf		Yes	Yes	Fillable Fileable
Other-email			LRP Applicant Survey Form A - Invitation Email.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 594	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	594	594
Annual IC Time Burden (Hours)	40	40
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
The NIH Extramural Loan Repayment Programs: Online Post-Application Customer Service Survey for Applicants – Form A	LRP Applicant Survey Form A - PCB Fasttrack Template.doc	12/02/2016

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