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

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⚠️ Notice: This information collection may be referencing outdated material.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 Form
1 NIMH Core User Survey template NIMH Core User Survey Template 6.21.2018.docx Form
1 NIMH Core User Survey template NIMH Core User Survey Template 6.21.2018.docx Form
Request for OMB Clearance - Collection of Routine Customer Feedback (NIMH Core Facility User Survey2).docx National Institute of Mental Health (NIMH) Core Facility User Survey fast track IC Document
Request for OMB Clearance - Collection of Routine Customer Feedback (NIMH Core Facility User Survey2).docx National Institute of Mental Health (NIMH) Core Facility User Survey fast track IC Document

Information Collection (IC) Details

IC Title:	National Institute of Mental Health (NIMH) Core Facility User Survey	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	NIMH Core User Survey template	NIMH Core User Survey Template 6.21.2018.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 85	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	85	85
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
National Institute of Mental Health (NIMH) Core Facility User Survey fast track	Request for OMB Clearance - Collection of Routine Customer Feedback (NIMH Core Facility User Survey2).docx	06/25/2018

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