Information Collection

Mentors

IC 195976 under ICR 201101-0925-005 · OMB 0925-0629.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 4 Mentors	Form and Instruction
4 Mentors Survey Mentor Survey CTSA OMB attach 1.doc	Form and Instruction

IC Title:

Mentors

Agency IC Tracking Number:

Is this a Common Form? No

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	4	Mentors Survey	Mentor Survey CTSA OMB attach 1.doc		Yes	Yes	Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,350

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 Agency Discretion
Annual Number of Responses for this IC	338	338
Annual IC Time Burden (Hours)	169	169
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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