Information Collection

Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits

IC 218941 under ICR 201501-0925-004 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits	Form and Instruction
1 Customer Satisfaction Survey 2015 MtG Customer Satisfaction Survey - Survey Monkey Screenshot.docx	Form and Instruction
Fast Track Template NP - Mind the Gap Evaluation_11 09 15.doc Fast Track Submission Form -Not for profit	IC Document

IC Title:

Medicine: Mind the Gap NIH Seminar Series Survey-Not-For-Profits

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	Customer Satisfaction Survey	2015 MtG Customer Satisfaction Survey - Survey Monkey Screenshot.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: 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	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast Track Submission Form -Not for profit	Fast Track Template NP - Mind the Gap Evaluation_11 09 15.doc	11/12/2015

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