Information Collection

Researchers

IC 204858 under ICR 201211-0925-008 · OMB 0925-0666.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Researchers	Form and Instruction
1 Survey Attachment 2_SGI survey_screenshots_v2.docx	Form and Instruction
Attachment 1_SGI-SurveyQuestions_v2.docx Attachment 1_SGI-SurveyQuestions_v2	IC Document

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:

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	1	Survey	Attachment 2_SGI survey_screenshots_v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

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	150	150
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Attachment 1_SGI-SurveyQuestions_v2	Attachment 1_SGI-SurveyQuestions_v2.docx	11/13/2012

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