Information Collection

Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey

IC 216054 under ICR 201410-0925-002 · OMB 0925-0643.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0643 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey	Form and Instruction
1 MRRIN Pilot Project Survey 0925-0643_MRRIN Pilot Project Survey - Screenshots 4-10-15.docx	Form and Instruction
0925-0643_Fast Track Template 2015_MRRIN Survey.doc Fast Track Submission Form	IC Document
0925-0643_MRRIN Survey Consent Form (Word) 4-9-15.docx Consent Form	IC Document

IC Title:

Medical Rehabilitation Research Infrastructure Network (MRRIN) Pilot Project Customer Satisfaction Survey

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	MRRIN Pilot Project Survey	0925-0643_MRRIN Pilot Project Survey - Screenshots 4-10-15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: 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	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Submission Form	0925-0643_Fast Track Template 2015_MRRIN Survey.doc	04/10/2015
Consent Form	0925-0643_MRRIN Survey Consent Form (Word) 4-9-15.docx	04/10/2015

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