Host Institutions/Applicants

Request for Generic Clearance to Conduct Voluntary Customer/Partner Surveys(NLM)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0476 can be found here:

Documents and Forms

Document Name Document Type
Form 2 Host Institutions/Applicants Form and Instruction
2 Applicants FINAL Customer Satisfaction Survey for Applicant 03-15-2011[1].docx Form and Instruction
1 Host FINAL Customer Satisfaction Survey for Host Institutions 03-15-2011.docx Form and Instruction
FINAL Mini Support Statement for Survey for Host Institutions 03-04-2011 OMB.docx FINAL Mini Support Statement for Survey for Host Institutions 03-04-2011 OMB IC Document
FINAL Mini Support Statement for Survey for Applicants 03-04-2011 OMB.docx FINAL Mini Support Statement for Survey for Applicants 03-04-2011 OMB IC Document
NLM Generic Clearance Request Form_Survey for Applicants 03-04-2011 OMB.doc NLM Generic Clearance Request Form_Survey for Applicants 03-04-2011 OMB IC Document
NLM Generic Clearance Request Form_Survey for Host Institutions Cover Memo 03-04-2011 OMB.doc NLM Generic Clearance Request Form_Survey for Host Institutions Cover Memo 03-04-2011 OMB IC Document
Response to Questions B3 and B4 - survey for applicants.docx Response to Questions B3 and B4 - survey for applicants IC Document
Response to Questions B3 and B4 - survey for host institutions.docx Response to Questions B3 and B4 - survey for host institutions IC Document

Information Collection (IC) Details

IC Title:	Host Institutions/Applicants	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 and Instruction	2	Applicants	FINAL Customer Satisfaction Survey for Applicant 03-15-2011[1].docx		Yes	Yes	Paper Only
Form and Instruction	1	Host	FINAL Customer Satisfaction Survey for Host Institutions 03-15-2011.docx		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 188	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	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	188	0	0	0	0	0
Annual IC Time Burden (Hours)	47	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
FINAL Mini Support Statement for Survey for Host Institutions 03-04-2011 OMB	FINAL Mini Support Statement for Survey for Host Institutions 03-04-2011 OMB.docx	03/24/2011
FINAL Mini Support Statement for Survey for Applicants 03-04-2011 OMB	FINAL Mini Support Statement for Survey for Applicants 03-04-2011 OMB.docx	03/24/2011
NLM Generic Clearance Request Form_Survey for Applicants 03-04-2011 OMB	NLM Generic Clearance Request Form_Survey for Applicants 03-04-2011 OMB.doc	03/28/2011
NLM Generic Clearance Request Form_Survey for Host Institutions Cover Memo 03-04-2011 OMB	NLM Generic Clearance Request Form_Survey for Host Institutions Cover Memo 03-04-2011 OMB.doc	03/28/2011
Response to Questions B3 and B4 - survey for applicants	Response to Questions B3 and B4 - survey for applicants.docx	04/06/2011
Response to Questions B3 and B4 - survey for host institutions	Response to Questions B3 and B4 - survey for host institutions.docx	04/06/2011

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