Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form

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⚠️ Notice: This information collection may be referencing outdated material.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 Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form Form and Instruction
1 BYOMM KAB Form BYOMM KAB Form_Revised 10.12.17.pdf Form and Instruction
Fast Track OMB Clerarance - NIMHD BYOMM KAB_10-06-2017.docx Brother, You’re on My Mind (BYOMM) Knowledge Attitudes and Believes Form IC Document

Information Collection (IC) Details

IC Title:	Brother, You're on My Mind (BYOMM) Knowledge Attitudes and Believes Form	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	BYOMM KAB Form	BYOMM KAB Form_Revised 10.12.17.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 600	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	600	600
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Brother, You’re on My Mind (BYOMM) Knowledge Attitudes and Believes Form	Fast Track OMB Clerarance - NIMHD BYOMM KAB_10-06-2017.docx	10/13/2017

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