Awardee Survey (US and HIC)

Feedback Survey for the Brain Disorders in the Developing World Program of the John E. Fogarty International Center (FIC)

Documents and Forms

Document Name Document Type
Att1 Informed Consent.docx Instruction
2 US and HIC Att4 US Survey Instrument.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Awardee Survey (US and HIC)	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
Instruction			Att1 Informed Consent.docx		No	No	Paper Only
Form and Instruction	2	US and HIC	Att4 US Survey Instrument.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 99	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	99	99
Annual IC Time Burden (Hours)	58	58
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.