Chair 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⚠️ Notice: This information collection may be referencing outdated material.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 Chair Survey Form and Instruction
ChairFairSurvey_Comm_2017_05_16-rev2.docx Other-E-mail
1 Chair Fair Survey Chair Fair Survey.pdf Form and Instruction
PRA Fast Track-ChairFair.doc Chair Survey IC Document

Information Collection (IC) Details

IC Title:	Chair 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	Chair Fair Survey	Chair Fair Survey.pdf		Yes	Yes	Fillable Fileable
Other-E-mail			ChairFairSurvey_Comm_2017_05_16-rev2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	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	300	300
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Chair Survey	PRA Fast Track-ChairFair.doc	06/01/2017

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