Evaluation of the Enhancing Diversity of the NIH-funded Workforce Program for the National Institute of General Medical Sciences (NIGMS)

Forms and Documents

Document Name	Status
Form 19 NRMN Case Study Interviews Faculty mentees Form and Instruction	New
Form 19 NRMN Case Study Interviews Student mentees Form and Instruction	New
Form 19 NRMN Case Study Interviews Mentors Form and Instruction	New
Form 19 NRMN Case Study Interviews Investigators Form and Instruction	New
Form 19 NRMN Site Visit Form and Instruction	New
Form 18 NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2018 Cohort Form and Instruction	New
Form 17 NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2017 Cohort Form and Instruction	New
Form 17 NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2016 Cohort Form and Instruction	New
Form 14 NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2018 faculty cohort Form and Instruction	New
Form 14 NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2018 student cohort Form and Instruction	New
Form 14 NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2017 faculty cohort Form and Instruction	New
Form 14 NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2017 student cohort Form and Instruction	New
Form 14 NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2016 faculty cohort Form and Instruction	New
Form 14 NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2016 student cohort Form and Instruction	New
Form 13 NRMN Mentor Annual Follou-up Surveys 2018 Cohort Form and Instruction	New
Form 13 NRMN Mentor Annual Follou-up Surveys 2017 Cohort Form and Instruction	New
Form 13 NRMN Mentor Annual Follou-up Surveys 2016 Cohort Form and Instruction	New
Form 12 NRMN Mentee Annual Follow-up Surverys 2018 Faculty Cohorts Form and Instruction	New
Form 12 NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts Form and Instruction	New
Form 12 NRMN Mentee Annual Follow-up Surverys 2017 Faculty Cohorts Form and Instruction	New
Form 12 NRMN Mentee Annual Follow-up Surverys 2017 student Cohorts Form and Instruction	New
Form 12 NRMN Mentee Annual Follow-up Surverys 2016 Faculty Cohorts Form and Instruction	New
Form 12 NRMN Mentee Annual Follow-up Surverys 2016 student Cohorts Form and Instruction	New
Form 11 BUILD Case Study Interviews PI's, Program Managers/Directors, & Faculty Form and Instruction	New
Form 11 BUILD Case Study Interviews Graduate/post-doctoral Students Form and Instruction	New
Form 11 BUILD Case Study Interviews Undergraduate Students Form and Instruction	New
Form 11 BUILD Case Studies Preparation Form and Instruction	New
Form 11 BUILD Site Visits Form and Instruction	New
Form 10 BUILD Implementation Reports Form and Instruction	New
Form 9 BUILD Institutional Research & Program Data Requests Form and Instruction	New
Form 8 BUILD Mentee Mentor Assessment Form and Instruction	New
Form 7 BUILD Faculty Annual Follow-up survey Form and Instruction	New
Form 6 BUILD Faculty Survey (HERI Faculty Survey) Form and Instruction	New
Form 5 BUILD Student Annual Follow-up Survey 2017 Cohort Form and Instruction	New
Form 5 BUILD Student Annual Follow-up Survey 2016 Cohort Form and Instruction	New
Form 5 BUILD Student Annual Follow-up Survey 2015 Cohort Form and Instruction	New
Form 4 BUILD Student - Follow-up survey at graduation (HERI College Senior Survey) Form and Instruction	New
Form 3 BUILD Student - Follow up survey at the end of the first attendance year (HERI Your First College Year) Form and Instruction	New
Form 1 BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers Form and Instruction	New
30-day FRN2016-14739.pdf Supplementary Document	2016-06-22
Revised_Diversity_OMB_Section_A_ 6_15_16.docx Supporting Statement A	2016-11-04
Attachment_07_-_NRMN_Logic_Model.pdf Supplementary Document	2016-06-15
Attachment_06_-_BUILD_Logic_Models.pdf Supplementary Document	2016-06-15
Attachment_05_-_BUILD_Interventions_Summary_Table.pdf Supplementary Document	2016-06-15
Attachment_04_-_Hallmarks_of_Success.pdf Supplementary Document	2016-06-15
Attachment_03_-_RFA-RM-13-015_(Coordination_&_Evaluation_Center).pdf Supplementary Document	2016-06-15
Attachment_02_-_RFA-RM-13-017_(National_Research_Mentoring_Network_(NRMN)).pdf Supplementary Document	2016-06-15
Attachment_01_-_RFA-RM-13-016_(Building_Infrastructure_Leading_to_Diversity_(BUILD)).pdf Supplementary Document	2016-06-15
Revision to Privacy Act Memo.pdf Supplementary Document	2016-06-15
Attachment A.11-NIH Privacy Act Officer Correspondence RE-Evaluation of Diversity of NIH-Funded Workforce 2016.pdf Supplementary Document	2016-06-15
Data Sharing Policy ESC Approved 031616.docx Supplementary Document	2016-06-15
Attachment_28_-_Advisory_Committe_to_the_Director-Working_Group_on_Diversity_in_the_Biomedical_Research_Workforce_Membership.pdf Supplementary Document	2016-06-15
Attachment_27_-_Coordination_&_Evaluation_Center_(CEC)_Tracker_Security_Overview.pdf Supplementary Document	2016-06-15
Diversity OMB Summary Statement B 5-9-2016 V3Final.docx Supporting Statement B	2016-06-15

IC Document Collections

IC ID	Document Title	Status
222057	NRMN Case Study Interviews Faculty mentees Form and Instruction	New
222056	NRMN Case Study Interviews Student mentees Form and Instruction	New
222055	NRMN Case Study Interviews Mentors Form and Instruction	New
222053	NRMN Case Study Interviews Investigators Form and Instruction	New
222010	NRMN Site Visit Form and Instruction	New
222003	NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2018 Cohort Form and Instruction	New
222000	NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2017 Cohort Form and Instruction	New
221996	NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2016 Cohort Form and Instruction	New
221993	NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2018 faculty cohort Form and Instruction	New
221991	NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2018 student cohort Form and Instruction	New
221990	NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2017 faculty cohort Form and Instruction	New
221989	NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2017 student cohort Form and Instruction	New
221988	NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2016 faculty cohort Form and Instruction	New
221986	NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2016 student cohort Form and Instruction	New
221981	NRMN Mentor Annual Follou-up Surveys 2018 Cohort Form and Instruction	New
221980	NRMN Mentor Annual Follou-up Surveys 2017 Cohort Form and Instruction	New
221979	NRMN Mentor Annual Follou-up Surveys 2016 Cohort Form and Instruction	New
221973	NRMN Mentee Annual Follow-up Surverys 2018 Faculty Cohorts Form and Instruction	New
221972	NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts Form and Instruction	New
221971	NRMN Mentee Annual Follow-up Surverys 2017 Faculty Cohorts Form and Instruction	New
221970	NRMN Mentee Annual Follow-up Surverys 2017 student Cohorts Form and Instruction	New
221969	NRMN Mentee Annual Follow-up Surverys 2016 Faculty Cohorts Form and Instruction	New
221968	NRMN Mentee Annual Follow-up Surverys 2016 student Cohorts Form and Instruction	New
221967	BUILD Case Study Interviews PI's, Program Managers/Directors, & Faculty Form and Instruction	New
221966	BUILD Case Study Interviews Graduate/post-doctoral Students Form and Instruction	New
221965	BUILD Case Study Interviews Undergraduate Students Form and Instruction	New
221964	BUILD Case Studies Preparation Form and Instruction	New
221963	BUILD Site Visits Form and Instruction	New
221962	BUILD Implementation Reports Form and Instruction	New
221961	BUILD Institutional Research & Program Data Requests Form and Instruction	New
221960	BUILD Mentee Mentor Assessment Form and Instruction	New
221959	BUILD Faculty Annual Follow-up survey Form and Instruction	New
221958	BUILD Faculty Survey (HERI Faculty Survey) Form and Instruction	New
221957	BUILD Student Annual Follow-up Survey 2017 Cohort Form and Instruction	New
221956	BUILD Student Annual Follow-up Survey 2016 Cohort Form and Instruction	New
221955	BUILD Student Annual Follow-up Survey 2015 Cohort Form and Instruction	New
221954	BUILD Student - Follow-up survey at graduation (HERI College Senior Survey) Form and Instruction	New
221953	BUILD Student - Follow up survey at the end of the first attendance year (HERI Your First College Year) Form and Instruction	New
221951	BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers Form and Instruction	New

ICR Details

OMB Control No: 0925-0747	ICR Reference No: 201606-0925-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Evaluation of the Enhancing Diversity of the NIH-funded Workforce Program for the National Institute of General Medical Sciences (NIGMS)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 11/15/2016
	Date Received in OIRA: 06/23/2016
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	11/30/2019	36 Months From Approved
Responses	90,723	0	0
Time Burden (Hours)	61,950	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a NEW OMB application request for a three year clearance to conduct an evaluation of the NIH Common Fund’s “Enhancing the Diversity of the NIH-funded Workforce Program.” This program is a national consortium, comprised of three integrated initiatives: 1) Building Infrastructure Leading to Diversity (BUILD) Initiative (RFA-RM-13-016; see Attachment 1), 2) National Research Mentoring Network (NRMN) (RFA-RM-13-017; see Attachment 2) and 3) Coordination and Evaluation Center (CEC) for Enhancing the Diversity of the NIH-Funded Workforce Program (RFA-RM-13-015; see Attachment 3).

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Authorizing Statute(s): US Code: 42 USC sect. 284n Name of Law: National Institutes of Health Reform Act of 2006
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 58270	09/28/2015
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 40712	06/22/2016
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 39

IC Title	Form No.	Form Name
BUILD Faculty Annual Follow-up survey	7	BUILD Student Annual Followup Survey
BUILD Mentee Mentor Assessment	8	Mentee Mentor Assessment
BUILD Implementation Reports	10	BUILD Implementation Reports
BUILD Case Studies Preparation	11	BUILD Site Visit and Case Studies protocol
NRMN Case Study Interviews Student mentees	19	NRMN Site visit and Case Studies Protocol
NRMN Case Study Interviews Investigators	19	NRMN Site visit and Case Studies Protocol
BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers	2, 1	HERI Freshman Survey (On-line Version) ,   HERI Freshman Survey (Paper Version)
BUILD Faculty Survey (HERI Faculty Survey)	6	HERI Faculty Survey
BUILD Institutional Research & Program Data Requests	9	BUILD Institutional Records and Program Data Requests
BUILD Site Visits	11	BUILD Site Visit and Case Studies protocol
BUILD Case Study Interviews Undergraduate Students	11	BUILD Site Visit and Case Studies protocol
NRMN Mentee Annual Follow-up Surverys 2016 student Cohorts	12	NRMN Student Mentee Core Followup Survey
NRMN Mentee Annual Follow-up Surverys 2018 Faculty Cohorts	12	NRMN Student Mentee Core Followup Survey
BUILD Student - Follow-up survey at graduation (HERI College Senior Survey)	4	HERI College Senior Survey
BUILD Student Annual Follow-up Survey 2016 Cohort	5	BUILD Student Annual Followup Survey
NRMN Mentee Annual Follow-up Surverys 2017 student Cohorts	12	NRMN Student Mentee Core Followup Survey
NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts	12	NRMN Student Mentee Core Followup Survey
BUILD Student - Follow up survey at the end of the first attendance year (HERI Your First College Year)	3	HERI Your First College Year
BUILD Student Annual Follow-up Survey 2015 Cohort	5	BUILD Student Annual Followup Survey
BUILD Student Annual Follow-up Survey 2017 Cohort	5	BUILD Student Annual Followup Survey
BUILD Case Study Interviews Graduate/post-doctoral Students	11	BUILD Site Visit and Case Studies protocol
BUILD Case Study Interviews PI's, Program Managers/Directors, & Faculty	11	BUILD Site Visit and Case Studies protocol
NRMN Case Study Interviews Mentors	19	NRMN Site visit and Case Studies Protocol
NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2016 faculty cohort	14, 15, 16	Mentee Mentor Assessment ,   NRMN Research and Grant Writing ,   NRMN Institutional context Module
NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2018 student cohort	14, 15, 16	Mentee Mentor Assessment ,   NRMN Research and Grant Writing ,   NRMN Institutional context Module
NRMN Case Study Interviews Faculty mentees	19	NRMN Site visit and Case Studies Protocol
NRMN Mentee Annual Follow-up Surverys 2016 Faculty Cohorts	12	NRMN Student Mentee Core Followup Survey
NRMN Mentee Annual Follow-up Surverys 2017 Faculty Cohorts	12	NRMN Student Mentee Core Followup Survey
NRMN Mentor Annual Follou-up Surveys 2017 Cohort	13	NRMN Faculty Mentor Core Followup Survey
NRMN Mentor Annual Follou-up Surveys 2018 Cohort	13	NRMN Faculty Mentor Core Followup Survey
NRMN Mentor Annual Follou-up Surveys 2016 Cohort	13	NRMN Faculty Mentor Core Followup Survey
NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2016 student cohort	14, 15, 16	Mentee Mentor Assessment ,   NRMN Research and Grant Writing ,   NRMN Institutional context Module
NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2017 student cohort	14, 15, 16	Mentee Mentor Assessment ,   NRMN Research and Grant Writing ,   NRMN Institutional context Module
NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2017 faculty cohort	14, 15, 16	Mentee Mentor Assessment ,   NRMN Research and Grant Writing ,   NRMN Institutional context Module
NRMN Mentees - Program Specific modules for tracking survey: Mentee Assessment of Mentor, Research & Grant Wring, Institutional Context 2018 faculty cohort	16, 14, 15	Mentee Mentor Assessment ,   NRMN Research and Grant Writing ,   NRMN Institutional context Module
NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2016 Cohort	18, 17, 16	NRMN Mentor Skills ,   NRMN Coaching Training Module ,   NRMN Institutional context Module
NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2017 Cohort	17, 18, 16	NRMN Mentor Skills ,   NRMN Coaching Training Module ,   NRMN Institutional context Module
NRMN Mentors - Program Specific modules for tracking survey: Mentor Skills, Coaching Training, Institutional Context 2018 Cohort	18, 16, 17	NRMN Coaching Training Module ,   NRMN Institutional context Module ,   NRMN Mentor Skills
NRMN Site Visit	19	NRMN Site visit and Case Studies Protocol

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	90,723	0	0	90,723	0	0
Annual Time Burden (Hours)	61,950	0	0	61,950	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: NEW submission

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Annual Cost to Federal Government: $5,269

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/23/2016

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