NICHD DASH -Study Request and/or Study Submission Survey (individuals)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NICHD)

Documents and Forms

Document Name Document Type
Form 1 NICHD DASH -Study Request and/or Study Submission Survey (individuals) Form
1 NICHD DASH Submitter survey 0925-0643_substudy_NICHD DASH Study Submitter Survey.docx Form
2 NICHD DASH Study Requester Survey 0925-0643_Substudy _NICHD DASH Study Requester Survey.docx Form
0925-0643_substudy_NICHD DASH_2018_Individual.docx NICHD DASH 2018 Individual fast track template IC Document

Information Collection (IC) Details

IC Title:	NICHD DASH -Study Request and/or Study Submission Survey (individuals)	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	NICHD DASH Submitter survey	0925-0643_substudy_NICHD DASH Study Submitter Survey.docx		Yes	Yes	Fillable Fileable
Form	2	NICHD DASH Study Requester Survey	0925-0643_Substudy _NICHD DASH Study Requester Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 54	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	54	54
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
NICHD DASH 2018 Individual fast track template	0925-0643_substudy_NICHD DASH_2018_Individual.docx	06/25/2018

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