Form 1 DSEIS PRA Screenshots

�\. National Institutes of Health

Office of Research Services

�./ Office of Management

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Burden Disclosure: Public reporting burden for this collection of information is estimated to average of 5 minutes per response, including the time for reviewing instructions,
searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a
person is not required to respond to, a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974,
ATTN: PRA (0925-0648) Do not return the completed form to this address.
Introduction: The Division of Scientific Equipment and Instrumentation Services (DSEIS) survey asks you about recent equipment maintenance or repair services we provided you.
Survey responses reside behind the NIH firewall and are secure to the extent permitted by law. For each question select the option that best represents your view. The survey will take
a bout 5 minutes to complete. Try to answer each question within the survey as honestly and accurately as possible. Questions about this survey can be sent to Dr. Janice Rouiller,
with the NIH Office of Research Services (ORS) Office of Quality Management (OQM) at ORSSurveySystem@mail.nih.gov
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OMB#: 0925-0648 Exp., date: 05/31/2021

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