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

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 19 NRMN Site visit and Case Studies Protocol	Form and Instruction	Unchanged	Available
Form 19 NRMN Site visit and Case Studies Protocol	Form and Instruction	Unchanged	Available
Form 19 NRMN Site visit and Case Studies Protocol	Form and Instruction	Unchanged	Available
Form 19 NRMN Site visit and Case Studies Protocol	Form and Instruction	Unchanged	Available
Form 19 NRMN Site visit and Case Studies Protocol	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 18 NRMN Coaching Training Module	Form and Instruction	Unchanged	Available
Form 17 NRMN Mentor Skills	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 18 NRMN Coaching Training Module	Form and Instruction	Unchanged	Available
Form 17 NRMN Mentor Skills	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 18 NRMN Coaching Training Module	Form and Instruction	Unchanged	Available
Form 17 NRMN Mentor Skills	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 15 NRMN Research and Grant Writing	Form and Instruction	Unchanged	Available
Form 14 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 15 NRMN Research and Grant Writing	Form and Instruction	Unchanged	Available
Form 14 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 15 NRMN Research and Grant Writing	Form and Instruction	Unchanged	Available
Form 14 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 14 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 15 NRMN Research and Grant Writing	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 15 NRMN Research and Grant Writing	Form and Instruction	Unchanged	Available
Form 14 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 16 NRMN Institutional context Module	Form and Instruction	Unchanged	Available
Form 15 NRMN Research and Grant Writing	Form and Instruction	Unchanged	Available
Form 14 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 13 NRMN Faculty Mentor Core Followup Survey	Form and Instruction	Unchanged	Available
Form 13 NRMN Faculty Mentor Core Followup Survey	Form and Instruction	Unchanged	Available
Form 13 NRMN Faculty Mentor Core Followup Survey	Form and Instruction	Unchanged	Available
Form 12 NRMN Student Mentee Core Followup Survey	Form and Instruction	Unchanged	Available
Form 12 NRMN Student Mentee Core Followup Survey	Form and Instruction	Unchanged	Available
Form 12 NRMN Student Mentee Core Followup Survey	Form and Instruction	Unchanged	Available
Form 12 NRMN Student Mentee Core Followup Survey	Form and Instruction	Unchanged	Available
Form 12 NRMN Student Mentee Core Followup Survey	Form and Instruction	Unchanged	Available
Form 12 NRMN Student Mentee Core Followup Survey	Form and Instruction	Unchanged	Available
Form 11 BUILD Site Visit and Case Studies protocol	Form and Instruction	Unchanged	Available
Form 11 BUILD Site Visit and Case Studies protocol	Form and Instruction	Unchanged	Available
Form 11 BUILD Site Visit and Case Studies protocol	Form and Instruction	Unchanged	Available
Form 11 BUILD Site Visit and Case Studies protocol	Form and Instruction	Unchanged	Available
Form 11 BUILD Site Visit and Case Studies protocol	Form and Instruction	Unchanged	Available
Form 10 BUILD Implementation Reports	Form and Instruction	Unchanged	Available
Form 9 BUILD Institutional Records and Program Data Requests	Form and Instruction	Unchanged	Available
Form 8 Mentee Mentor Assessment	Form and Instruction	Unchanged	Available
Form 7 BUILD Student Annual Followup Survey	Form and Instruction	Unchanged	Available
Form 6 HERI Faculty Survey	Form and Instruction	Unchanged	Available
Form 5 BUILD Student Annual Followup Survey	Form and Instruction	Unchanged	Available
Form 5 BUILD Student Annual Followup Survey	Form and Instruction	Unchanged	Available
Form 5 BUILD Student Annual Followup Survey	Form and Instruction	Unchanged	Available
Form 4 HERI College Senior Survey	Form and Instruction	Unchanged	Available
Form 3 HERI Your First College Year	Form and Instruction	Unchanged	Available
Form 2 HERI Freshman Survey (Paper Version)	Form and Instruction	Unchanged	Available
Form 1 HERI Freshman Survey (On-line Version)	Form and Instruction	Unchanged	Available
Attachment_19_(Revised 7.31.17)-_NRMN_Mentor_Skills_Module.pdf	Supplementary Document	Uploaded 2017-09-13	Available
Attachment_18_(Revised 7.31.17) - NRMN_Student_Mentee_Followup_Survey.pdf	Supplementary Document	Uploaded 2017-09-13	Available
Attachment_17_(Revised 7.31.17) - NRMN_Faculty_Mentor_Core_Followup_Survey.pdf	Supplementary Document	Uploaded 2017-09-13	Available
Attachment_15_(Revised 7.31.17)-_Mentee_Mentor_Assessment.pdf	Supplementary Document	Uploaded 2017-09-13	Available
Attachment_14_(Revised 7.31.17) -BUILD_Faculty_Annual_Followup_Survey.pdf	Supplementary Document	Uploaded 2017-09-13	Available
Change Request Memo.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-09-13	Available
mods to BUILD STUDENT Annual FollowUp Survey 170225 OMB tracked1.docx	Supplementary Document	Uploaded 2017-03-13	Available
DPC CEC 2017 survey modification request memo 03.10.17[5].docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-03-13	Available
30-day FRN2016-14739.pdf	Supplementary Document	Uploaded 2016-06-22	Available
Revised_Diversity_OMB_Section_A_ 6_15_16.docx	Supporting Statement A	Uploaded 2016-11-04	Available
Attachment_07_-_NRMN_Logic_Model.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_06_-_BUILD_Logic_Models.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_05_-_BUILD_Interventions_Summary_Table.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_04_-_Hallmarks_of_Success.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_03_-_RFA-RM-13-015_(Coordination_&_Evaluation_Center).pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_02_-_RFA-RM-13-017_(National_Research_Mentoring_Network_(NRMN)).pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_01_-_RFA-RM-13-016_(Building_Infrastructure_Leading_to_Diversity_(BUILD)).pdf	Supplementary Document	Uploaded 2016-06-15	Available
Revision to Privacy Act Memo.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment A.11-NIH Privacy Act Officer Correspondence RE-Evaluation of Diversity of NIH-Funded Workforce 2016.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Data Sharing Policy ESC Approved 031616.docx	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_28_-_Advisory_Committe_to_the_Director-Working_Group_on_Diversity_in_the_Biomedical_Research_Workforce_Membership.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Attachment_27_-_Coordination_&_Evaluation_Center_(CEC)_Tracker_Security_Overview.pdf	Supplementary Document	Uploaded 2016-06-15	Available
Diversity OMB Summary Statement B 5-9-2016 V3Final.docx	Supporting Statement B	Uploaded 2016-06-15	Available

IC Document Collections

Information collection document groups

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

ICR Details

OMB Control No: 0925-0747	ICR Reference No: 201709-0925-003
Status: Historical Active	Previous ICR Reference No: 201703-0925-001
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: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/15/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 09/14/2017
Terms of Clearance:

table that charts list comparision

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

table that charts list of burden

IC Title	Form No.	Form Name
BUILD Case Studies Preparation	11	BUILD Site Visit and Case Studies protocol
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
BUILD Case Study Interviews Undergraduate Students	11	BUILD Site Visit and Case Studies protocol
BUILD Faculty Annual Follow-up survey	7	BUILD Student Annual Followup Survey
BUILD Faculty Survey (HERI Faculty Survey)	6	HERI Faculty Survey
BUILD Implementation Reports	10	BUILD Implementation Reports
BUILD Institutional Research & Program Data Requests	9	BUILD Institutional Records and Program Data Requests
BUILD Mentee Mentor Assessment	8	Mentee Mentor Assessment
BUILD Site Visits	11	BUILD Site Visit and Case Studies protocol
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 - Follow-up survey at graduation (HERI College Senior Survey)	4	HERI College Senior Survey
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 Student Annual Follow-up Survey 2015 Cohort	5	BUILD Student Annual Followup Survey
BUILD Student Annual Follow-up Survey 2016 Cohort	5	BUILD Student Annual Followup Survey
BUILD Student Annual Follow-up Survey 2017 Cohort	5	BUILD Student Annual Followup Survey
NRMN Case Study Interviews Faculty mentees	19	NRMN Site visit and Case Studies Protocol
NRMN Case Study Interviews Investigators	19	NRMN Site visit and Case Studies Protocol
NRMN Case Study Interviews Mentors	19	NRMN Site visit and Case Studies Protocol
NRMN Case Study Interviews Student 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 2016 student 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 Mentee Annual Follow-up Surverys 2017 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
NRMN Mentee Annual Follow-up Surverys 2018 student Cohorts	12	NRMN Student Mentee Core Followup Survey
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 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 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 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 2018 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 Mentor Annual Follou-up Surveys 2016 Cohort	13	NRMN Faculty Mentor 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 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 Mentor Skills ,   NRMN Coaching Training Module ,   NRMN Institutional context Module
NRMN Site Visit	19	NRMN Site visit and Case Studies Protocol

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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	90,723	90,723	0	0	0	0
Annual Time Burden (Hours)	61,950	61,950	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

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

Burden Increase Due to:

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

Burden Reduction Due to:

Short Statement:

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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

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     No

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     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: 09/14/2017

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