Information Collection

Health Disparities Research Institute (HDRI) (NIMHD)

IC 225774 under ICR 201602-0925-001 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Health Disparities Research Institute (HDRI) (NIMHD)	Form and Instruction
1 HDRI Application 2017 HDRI Application 2017.docx	Form and Instruction
HDRI Sub-Study Template NIH Wide Generic.doc HDRI sub-study template	IC Document

IC Title:

Health Disparities Research Institute (HDRI) (NIMHD)

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	HDRI Application 2017	HDRI Application 2017.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: 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)	83	83
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
HDRI sub-study template	HDRI Sub-Study Template NIH Wide Generic.doc	02/21/2017

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