National Institute of Mental Health (NIMH) Core Facility User Survey (NIMH)

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⚠️ Notice: This information collection may be referencing outdated material.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 National Institute of Mental Health (NIMH) Core Facility User Survey (NIMH) Form
1 Core User Survey revised Core User Survey_Revised.docx Form
1 Core User Survey revised Core User Survey_Revised.docx Form
NIH Generic 0648 Template - NIMH Core Facility User Survey_For Submission.docx fast track for Core Facility User Survey IC Document
NIH Generic 0648 Template - NIMH Core Facility User Survey_For Submission.docx fast track for Core Facility User Survey IC Document

Information Collection (IC) Details

IC Title:	National Institute of Mental Health (NIMH) Core Facility User Survey (NIMH)	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	Core User Survey revised	Core User Survey_Revised.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 225	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	225	225
Annual IC Time Burden (Hours)	23	23
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track for Core Facility User Survey	NIH Generic 0648 Template - NIMH Core Facility User Survey_For Submission.docx	03/24/2021

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