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Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)
Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)
OMB: 0925-0648
IC ID: 237252
OMB.report
HHS/NIH
OMB 0925-0648
ICR 202104-0925-001
IC 237252
( )
⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:
2024-06-25 - Extension without change of a currently approved collection
2023-08-25 - No material or nonsubstantive change to a currently approved collection
Documents and Forms
Document Name
Document Type
Form 1
Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)
Form and Instruction
1 2019 HDRI Final Course Assessment
2019 HDRI Final Course Assessment 8.5.19.docx
Form and Instruction
1 2019 HDRI Final Course Assessment
2019 HDRI Final Course Assessment 8.5.19.docx
Form and Instruction
2019 HDRI Fast Track Template.doc
2019 HDRI Course Assessment Fast Track
IC Document
2019 HDRI Fast Track Template.doc
2019 HDRI Course Assessment Fast Track
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)
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 and Instruction
1
2019 HDRI Final Course Assessment
2019 HDRI Final Course Assessment 8.5.19.docx
Yes
Yes
Fillable Fileable
Federal Enterprise Architecture Business Reference Module
Line of Business:
Health
Subfunction:
Health Care Services
Privacy Act System of Records
Title:
FR Citation:
Number of Respondents:
55
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
Program Change Due to New Statute
Program Change Due to Agency Discretion
Change Due to Adjustment in Agency Estimate
Change Due to Potential Violation of the PRA
Previously Approved
Annual Number of Responses for this IC
55
0
0
0
0
55
Annual IC Time Burden (Hours)
9
0
0
0
0
9
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
2019 HDRI Course Assessment Fast Track
2019 HDRI Fast Track Template.doc
08/05/2019
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.