Information Collection

Early Independence Award Program (EIA) Customer Satisfaction Surveys

IC 201763 under ICR 200906-0925-004 · OMB 0925-0476.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Early Independence Award Program (EIA) Customer Satisfaction Surveys	Form and Instruction
1 Host Institutions Hosts institutions screenshots survey 3-19-2012.pdf	Form and Instruction
2 Applicants Applicants screenshots survey versions A and B 3-19-2012.pdf	Form and Instruction
3 Editorial Board Customer Satisfaction Survey for Editorial Board Reviewers -Paper 03-19-2012.docx	Form and Instruction
4 Finalists Finalists screenshots survey 3-19-2012.pdf	Form and Instruction
NLM Generic Clearance Request Form_Survey for Host Institutions 3-19-2012 OMB.doc NLM Generic Clearance Request Form_Survey for Host Institutions 3-19-2012 OMB	IC Document
Mini Support Statement for Survey for Host Institutions 3-19-2012 OMB.docx Mini Support Statement for Survey for Host Institutions 3-19-2012 OMB	IC Document
NLM Generic Clearance Request Form_Survey for Applicants 3-19-2012 OMB.doc NLM Generic Clearance Request Form_Survey for Applicants 3-19-2012 OMB	IC Document
Mini Support Statement for Survey for Applicants 3-19-2012 OMB.docx Mini Support Statement for Survey for Applicants 3-19-2012 OMB	IC Document
NLM Generic Request Form_Survey for Editorial Board Reviewers 3-19-2012.doc NLM Generic Request Form_Survey for Editorial Board Reviewers 3-19-2012	IC Document
Mini Support Statement for Survey for Editorial Board Reviewers 3-19-2012 OMB.docx Mini Support Statement for Survey for Editorial Board Reviewers 3-19-2012 OMB	IC Document
NLM Generic Clearance Request Form_Survey for Finalists 3-19-2011 OMB.doc NLM Generic Clearance Request Form_Survey for Finalists 3-19-2011 OMB	IC Document
Mini Support Statement for Survey for Finalists 3-19-2012 OMB.docx Mini Support Statement for Survey for Finalists 3-19-2012 OMB	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Early Independence Award Program (EIA) Customer Satisfaction Surveys

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Host Institutions	Hosts institutions screenshots survey 3-19-2012.pdf	Yes	Yes	Fillable Printable
Form and Instruction	2	Applicants	Applicants screenshots survey versions A and B 3-19-2012.pdf	Yes	Yes	Fillable Printable
Form and Instruction	3	Editorial Board	Customer Satisfaction Survey for Editorial Board Reviewers -Paper 03-19-2012.docx	Yes	Yes	Paper Only
Form and Instruction	4	Finalists	Finalists screenshots survey 3-19-2012.pdf	Yes	Yes	Fillable Printable

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: 340

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	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	340	0	0	0	0	0
Annual IC Time Burden (Hours)	85	0	0	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
NLM Generic Clearance Request Form_Survey for Host Institutions 3-19-2012 OMB	NLM Generic Clearance Request Form_Survey for Host Institutions 3-19-2012 OMB.doc	03/28/2012
Mini Support Statement for Survey for Host Institutions 3-19-2012 OMB	Mini Support Statement for Survey for Host Institutions 3-19-2012 OMB.docx	03/28/2012
NLM Generic Clearance Request Form_Survey for Applicants 3-19-2012 OMB	NLM Generic Clearance Request Form_Survey for Applicants 3-19-2012 OMB.doc	03/28/2012
Mini Support Statement for Survey for Applicants 3-19-2012 OMB	Mini Support Statement for Survey for Applicants 3-19-2012 OMB.docx	03/28/2012
NLM Generic Request Form_Survey for Editorial Board Reviewers 3-19-2012	NLM Generic Request Form_Survey for Editorial Board Reviewers 3-19-2012.doc	03/28/2012
Mini Support Statement for Survey for Editorial Board Reviewers 3-19-2012 OMB	Mini Support Statement for Survey for Editorial Board Reviewers 3-19-2012 OMB.docx	03/28/2012
NLM Generic Clearance Request Form_Survey for Finalists 3-19-2011 OMB	NLM Generic Clearance Request Form_Survey for Finalists 3-19-2011 OMB.doc	03/28/2012
Mini Support Statement for Survey for Finalists 3-19-2012 OMB	Mini Support Statement for Survey for Finalists 3-19-2012 OMB.docx	03/28/2012

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