Information Collection

NLM GHR User Study Screening Survey

IC 224763 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⚠️ Notice: This information collection may be referencing outdated material.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 NLM GHR User Study Screening Survey	Form and Instruction
1 NLM GHR User Study Screening Survey Instrument NLM GHR User Study Screening Survey instrument.pdf	Form and Instruction
NIH Fast Track OMB - NLM GHR User Study Screening Survey.doc NLM GHR User Study Screening Survey	IC Document

IC Title:

NLM GHR User Study Screening 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	NLM GHR User Study Screening Survey Instrument	NLM GHR User Study Screening Survey instrument.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

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	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
NLM GHR User Study Screening Survey	NIH Fast Track OMB - NLM GHR User Study Screening Survey.doc	12/08/2016

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