2018 NLM SIS Emerging Adults Health Needs Assessment

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⚠️ Notice: This information collection may be referencing outdated material.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 2018 NLM SIS Emerging Adults Health Needs Assessment Form and Instruction
1 SIS Emerging Adults Focus Group survey instrument SIS Emerging Adults Focus Group Survey Instrument.docx Form and Instruction
2 SIS Emerging Adults Web Based Survey instrument SIS Emerging Adults Web Based Survey Instrument (screen shots).pdf Form
NLM Fast track_2018 NLM SIS Emerging Adults Health Needs Assessment.doc 2018 NLM SIS Emerging Adults Health Needs Assessment IC Document

Information Collection (IC) Details

IC Title:	2018 NLM SIS Emerging Adults Health Needs Assessment	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	SIS Emerging Adults Focus Group survey instrument	SIS Emerging Adults Focus Group Survey Instrument.docx		No		Paper Only
Form	2	SIS Emerging Adults Web Based Survey instrument	SIS Emerging Adults Web Based Survey Instrument (screen shots).pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 127	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 50 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	127	127
Annual IC Time Burden (Hours)	57	57
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
2018 NLM SIS Emerging Adults Health Needs Assessment	NLM Fast track_2018 NLM SIS Emerging Adults Health Needs Assessment.doc	03/06/2018

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