Information Collection

Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT)

IC 210644 under ICR 201302-0925-007 · OMB 0925-0589.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0589 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT)	Form and Instruction
1 Survey Screenshots Attach2_BEMT Survey Screenshots_10FEB2014.pdf	Form and Instruction
2 Follow-Up-Debriefing Attach4-BEMT_Follow-up_Debriefing Guide_21FEB2014.docx	Form and Instruction
Mini-SSB_BEMT_21FEB2104.doc Mini-SSB_BEMT_21FEB2104	IC Document
Gen-Sub-Study-Form_21FEB2014.doc Gen-Sub-Study-Form_21FEB2014	IC Document
Attach1_BEMT Invite Letter_16JAN2014.docx Attach1_BEMT Invite Letter_16JAN2014	IC Document
Attach3_Reminder Email_3JAN2014.doc Attach3_Reminder Email_3JAN2014	IC Document
Mini-SSA_BEMT_3-7-2014.doc Mini-SSA_BEMT_3-7-2014	IC Document

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Sub-study #10_Requirement Gathering for a Biobank Economic Modeling Tool (BEMT)

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	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey Screenshots	Attach2_BEMT Survey Screenshots_10FEB2014.pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	Follow-Up-Debriefing	Attach4-BEMT_Follow-up_Debriefing Guide_21FEB2014.docx		No	No	Printable Only

Federal Enterprise Architecture Business Reference Module

Line of Business: General Science and Innovation

Subfunction: Scientific and Technological Research and Innovation

Privacy Act System of Records

Title: SORN #09-25-0156, "Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service, HHS/PHS/NIH/OD"

FR Citation: 67 FR 60743

Number of Respondents: 450

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	450	450
Annual IC Time Burden (Hours)	752	752
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Mini-SSB_BEMT_21FEB2104	Mini-SSB_BEMT_21FEB2104.doc	02/24/2014
Gen-Sub-Study-Form_21FEB2014	Gen-Sub-Study-Form_21FEB2014.doc	02/24/2014
Attach1_BEMT Invite Letter_16JAN2014	Attach1_BEMT Invite Letter_16JAN2014.docx	02/24/2014
Attach3_Reminder Email_3JAN2014	Attach3_Reminder Email_3JAN2014.doc	02/24/2014
Mini-SSA_BEMT_3-7-2014	Mini-SSA_BEMT_3-7-2014.doc	03/07/2014

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