Researchers

End-of-Life and Palliative Care Science Needs Assessment: Funding Source Questionnaire (NINR)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0652 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Researchers Form and Instruction
1 Funding Source Questionnaire Attachment 1- FUNDING SOURCE QUESTIONNAIRE v5.doc Form and Instruction
Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2.docx Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2 IC Document

Information Collection (IC) Details

IC Title:	Researchers	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 and Instruction	1	Funding Source Questionnaire	Attachment 1- FUNDING SOURCE QUESTIONNAIRE v5.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 1,840	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 0 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,840	1,840
Annual IC Time Burden (Hours)	147	147
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2	Attachment 3-INFORMED CONSENT FUNDING SOURCE Q_v2.docx	09/14/2011

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