Information Collection

NRMN Mentor Annual Follou-up Surveys 2017 Cohort

IC 221980 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
Document Name	Document Type
Form 13 NRMN Mentor Annual Follou-up Surveys 2017 Cohort	Form and Instruction
13 NRMN Faculty Mentor Core Followup Survey Attachment_17_-_NRMN_Faculty_Mentor_Core_Followup_Survey.pdf	Form and Instruction

IC Title:

NRMN Mentor Annual Follou-up Surveys 2017 Cohort

Agency IC Tracking Number:

Is this a Common Form? No

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	13	NRMN Faculty Mentor Core Followup Survey	Attachment_17_-_NRMN_Faculty_Mentor_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 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	750	750
Annual IC Time Burden (Hours)	313	313
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
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.