Medicine: NIH Mind the Gap Webinar Series Survey II

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⚠️ Notice: This information collection may be referencing outdated material.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: NIH Mind the Gap Webinar Series Survey II Form
1 MtG Customer Satisfaction Survey - survey Monkey Scrensh 2018 MtG Customer Satisfaction Survey - Survey Monkey Screenshot v2.docx Form
Fast Track Template 2018 - Mind the Gap Evaluation_01.31.18_Clean.doc Medicine: NIH Mind the Gap Webinar Series Survey II IC Document

Information Collection (IC) Details

IC Title:	Medicine: NIH Mind the Gap Webinar Series Survey II	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	1	MtG Customer Satisfaction Survey - survey Monkey Screnshot	2018 MtG Customer Satisfaction Survey - Survey Monkey Screenshot v2.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: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Medicine: NIH Mind the Gap Webinar Series Survey II	Fast Track Template 2018 - Mind the Gap Evaluation_01.31.18_Clean.doc	02/02/2018

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