Information Collection

Leadership Forum 3 month Pre-Assessment

IC 213837 under ICR 201411-0925-002 · OMB 0925-0708.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Leadership Forum 3 month Pre-Assessment	Form and Instruction
1 Leadership Forum 3 month Pre-Assessment Attachment 1A_LeadForum 3 month Pre.doc	Form and Instruction

IC Title:

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	Leadership Forum 3 month Pre-Assessment	Attachment 1A_LeadForum 3 month Pre.doc		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Extramural Awards and Chartered Advisory Committees (IMPAC 2), Contract Information (DCIS), and Cooperative Agreement Information, HHS/NIH

FR Citation: 67 FR 60742

Number of Respondents: 18

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

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	18	18
Annual IC Time Burden (Hours)	36	36
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.