NIDDK Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 12 NIDDK/NHMA Feedback Form	Form and Instruction	New	Available
Form 11 NHMA Application Form	Form and Instruction	New	Available
Form 10 NIH-NMA Feedback Form	Form and Instruction	New	Available
Form 9 NIH-NMA Fellows Program on Careers in Academic Medicine Application	Form and Instruction	New	Available
Form 8 NMRI Mentor-Mentee Agreement Forms	Form and Instruction	New	Available
Form 7 NMRI Survey	Form and Instruction	New	Available
Form 6 NMRI Meeting Evaluation Form	Form and Instruction	New	Available
Form 5 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	New	Available
Form 4 DSRTP Feedback Form	Form and Instruction	New	Available
Form 3 Diversity Summer Research Training Program (DSRTP) Application	Form and Instruction	New	Available
Form 2 STEP-UP High School and Undergraduate Feedback Form	Form and Instruction	New	Available
Form 1 Short-Term Research Experience for Underrepresented Persons (STEP-UP)	Form and Instruction	New	Available
30-day FRN2016-21329.pdf	Supplementary Document	Uploaded 2016-09-07	Available
Privacy Impact Assessment (PIA).pdf	Supplementary Document	Uploaded 2016-08-08	Available
Memo from NIH Privacy Act Officer.pdf	Supplementary Document	Uploaded 2016-08-08	Available
(13) STEP-UP Contacts.pdf	Supplementary Document	Uploaded 2016-08-08	Available
OMHRC Supporting Statement A_final.doc	Supporting Statement A	Uploaded 2016-08-08	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
222877	NIDDK/NHMA Feedback Form	Form and Instruction	New	NIDDK/NHMA Feedback Form
222876	NIH/NHMA Fellows Program Application	Form and Instruction	New	NHMA Application Form
222875	NIH/NMA Feedback Form	Form and Instruction	New	NIH-NMA Feedback Form
222874	NIH/NMA Fellows Program on Careers in Academic Medicine Application	Form and Instruction	New	NIH-NMA Fellows Program on Careers in Academic Medicine Application
222873	NMRI Mentor/Mentee Agreement Forms	Form and Instruction	New	NMRI Mentor-Mentee Agreement Forms
222872	NMRI Survey Form	Form and Instruction	New	NMRI Survey
222871	NMRI Evaluation Form	Form and Instruction	New	NMRI Meeting Evaluation Form
222870	Network of Minority Research Invetigators (NMRI) Enrollment Form	Form and Instruction	New	Network of Minority Health Research Investigators (NMRI) Enrollment Form
222868	DSRTP Feedback Form	Form and Instruction	New	DSRTP Feedback Form
222867	Diversity Summer Research Training Program (DSRTP) Application	Form and Instruction	New	Diversity Summer Research Training Program (DSRTP) Application
222866	STEP-UP Student Feedback Form	Form and Instruction	New	STEP-UP High School and Undergraduate Feedback Form
222865	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	Form and Instruction	New	Short-Term Research Experience for Underrepresented Persons (STEP-UP)

ICR Details

OMB Control No: 0925-0748	ICR Reference No: 201608-0925-001
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: NIDDK Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications
Type of Information Collection: Existing collection in use without an OMB Control Number	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/21/2016
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/07/2016
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2019	36 Months From Approved
Responses	4,320	0	0
Time Burden (Hours)	2,569	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This is a New, Existing collection without OMB approval. The proposed information collection activity is necessary in order to determine the eligibility and quality of potential awardees for traineeships and mentorships in these programs.

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Authorizing Statute(s): US Code: 42 USC 241 and 282(b)(13) Name of Law: Public Health Service Act
  

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:
	81 FR 29877	05/13/2016
30-day Notice:	Federal Register Citation:	Citation Date:
	81 FR 61226	09/06/2016
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 12

table that charts list of burden

IC Title	Form No.	Form Name
DSRTP Feedback Form	4	DSRTP Feedback Form
Diversity Summer Research Training Program (DSRTP) Application	3	Diversity Summer Research Training Program (DSRTP) Application
NIDDK/NHMA Feedback Form	12	NIDDK/NHMA Feedback Form
NIH/NHMA Fellows Program Application	11	NHMA Application Form
NIH/NMA Feedback Form	10	NIH-NMA Feedback Form
NIH/NMA Fellows Program on Careers in Academic Medicine Application	9	NIH-NMA Fellows Program on Careers in Academic Medicine Application
NMRI Evaluation Form	6	NMRI Meeting Evaluation Form
NMRI Mentor/Mentee Agreement Forms	8	NMRI Mentor-Mentee Agreement Forms
NMRI Survey Form	7	NMRI Survey
Network of Minority Research Invetigators (NMRI) Enrollment Form	5	Network of Minority Health Research Investigators (NMRI) Enrollment Form
STEP-UP Student Feedback Form	2	STEP-UP High School and Undergraduate Feedback Form
Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	1	Short-Term Research Experience for Underrepresented Persons (STEP-UP)

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ICR Summary of Burden

table that charts list 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	4,320	0	0	4,320	0	0
Annual Time Burden (Hours)	2,569	0	0	2,569	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: This is an New, existing collection in use without OMB Control Number, which is considered a “Change Due to Violation.” In 2014 it was recognized that this database existed and thus PRA/OMB Clearance is being requested.

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Annual Cost to Federal Government: $217,540

Does this IC contain surveys, censuses, or employ statistical methods? No

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: 09/07/2016

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