Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities

Documents and Forms

Document Name Document Type
Form instrument #1 Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities Form
instrument #1 HBCU survey HBCU Revised Survey.doc Form
instrument #1 HBCU Survey hbcu tab c.doc Form
hbcu letter and consent OMB.doc HBCU letter and consent form IC Document
hbcu tab e.doc HBCU consent form IC Document
hbcu tab d.doc HBCU Letter IC Document
hbcu tab f.doc HBCU list IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Assessment of Historically Black Colleges and Universities Activities to Eliminate Health Disparities	Agency IC Tracking Number:

Is this a Common Form? No		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	instrument #1	HBCU Survey	hbcu tab c.doc		Yes	Yes	Fillable Fileable
Form	instrument #1	HBCU survey	HBCU Revised Survey.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction:

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 525	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	525	525
Annual IC Time Burden (Hours)	394	394
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
HBCU consent form	hbcu tab e.doc	08/30/2006
HBCU Letter	hbcu tab d.doc	08/30/2006
HBCU list	hbcu tab f.doc	08/30/2006
HBCU letter and consent form	hbcu letter and consent OMB.doc	12/15/2006

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