Information Collection

NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts

IC 221972 under ICR 201606-0925-006 · OMB 0925-0747.

⚠️ Notice: This information collection may be referencing outdated material.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 12 NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts Form and Instruction
12 NRMN Student Mentee Core Followup Survey Attachment_18_-_NRMN_Student_Mentee_Core_Followup_Survey.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts	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	12	NRMN Student Mentee Core Followup Survey	Attachment_18_-_NRMN_Student_Mentee_Core_Followup_Survey.pdf		Yes	Yes	Fillable Fileable

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: 375	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	375	375
Annual IC Time Burden (Hours)	156	156
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.