Diverse Voices Speaker Series Feedback Form (ORWH/OD)

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⚠️ Notice: This information collection may be referencing outdated material.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 Diverse Voices Speaker Series Feedback Form (ORWH/OD) Form
1 Diverse Voices Speaker Series Diverse Voices Speaker Series Instrument (1).docx Form
1 Diverse Voices Speaker Series Diverse Voices Speaker Series Instrument (1).docx Form
Diverse Voices feedback submission_2 (1).docx fast track Diverse Voices Speaker Series Feedback IC Document
Diverse Voices feedback submission_2 (1).docx fast track Diverse Voices Speaker Series Feedback IC Document

Information Collection (IC) Details

IC Title:	Diverse Voices Speaker Series Feedback Form (ORWH/OD)	Agency IC Tracking Number:

IC Status: Unchanged

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	Diverse Voices Speaker Series	Diverse Voices Speaker Series Instrument (1).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

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 %

	Requested	Previously Approved
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
fast track Diverse Voices Speaker Series Feedback	Diverse Voices feedback submission_2 (1).docx	02/01/2021

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