Change Readiness Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Document Name Document Type
Form 1 Change Readiness Survey Form
1 Change Readiness Survey ChangeReadinessSurvey_FINAL_2017-08-17.docx Form
OMB Form_6700B_ChangeReadinessSurvey_2017-08-17.docx Change Readiness Survey Fast track IC Document

Information Collection (IC) Details

IC Title:	Change Readiness Survey	Agency IC Tracking Number:

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
Form	1	Change Readiness Survey	ChangeReadinessSurvey_FINAL_2017-08-17.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 300	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Change Readiness Survey Fast track	OMB Form_6700B_ChangeReadinessSurvey_2017-08-17.docx	08/18/2017

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