BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0747 can be found here:

Documents and Forms

Document Name Document Type
Form 1 BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers Form and Instruction
1 HERI Freshman Survey (On-line Version) Attachment_08a_-_HERI_Freshman_Survey_(On-line_Version).pdf Form and Instruction
2 HERI Freshman Survey (Paper Version) Attachment_08b_-_HERI_Freshman_Survey_(Paper_Version).pdf Form and Instruction

Information Collection (IC) Details

IC Title:	BUILD Student -Entrance Survey (Version A: HERI Freshman Survey Version B: HERI Freshman Survey for Non-Freshman Transfers	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	1	HERI Freshman Survey (On-line Version)	Attachment_08a_-_HERI_Freshman_Survey_(On-line_Version).pdf		Yes	Yes	Fillable Fileable
Form and Instruction	2	HERI Freshman Survey (Paper Version)	Attachment_08b_-_HERI_Freshman_Survey_(Paper_Version).pdf		No		Paper Only

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service	FR Citation: 67 FR 187

Number of Respondents: 15,000	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	15,000	15,000
Annual IC Time Burden (Hours)	11,250	11,250
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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