Information Collection

Medical Students

IC 197526 under ICR 201104-0925-004 · OMB 0925-0635.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0635 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Medical Students Form
2 Survey 2 for Medical Students (Post-Survey 1 or 2) 6 - NIDA OMB B2-2 Survey 2 for Medical Students (Post Survey 1 or 2) 2-28-11 sh.docx Form
1 Medical Students Pre-Survey Attachment B2-1 Survey 1 for Medical Students (Pre Survey 1 or 2) 3-30-11 sh[1].doc Form
Attachment A1 Email Invitation to Medical Students 3-30-11 sh.docx Attachment A1 Email Invitation to Medical Students 3-30-11 sh IC Document
Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh.docx Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Medical Students	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	1	Medical Students Pre-Survey	Attachment B2-1 Survey 1 for Medical Students (Pre Survey 1 or 2) 3-30-11 sh[1].doc		Yes	Yes	Fillable Printable
Form	2	Survey 2 for Medical Students (Post-Survey 1 or 2)	6 - NIDA OMB B2-2 Survey 2 for Medical Students (Post Survey 1 or 2) 2-28-11 sh.docx		Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,600	1,600
Annual IC Time Burden (Hours)	272	272
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment A1 Email Invitation to Medical Students 3-30-11 sh	Attachment A1 Email Invitation to Medical Students 3-30-11 sh.docx	04/26/2011
Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh	Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh.docx	04/26/2011

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