Information Collection

NRMN Mentee Annual Follow-up Surverys 2017 student Cohorts

IC 221970 under ICR 201709-0925-003 · 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⚠️ Notice: This information collection may be referencing outdated material.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 12 NRMN Mentee Annual Follow-up Surverys 2017 student Cohorts	Form and Instruction
12 NRMN Student Mentee Core Followup Survey Attachment_18_-_NRMN_Student_Mentee_Core_Followup_Survey.pdf	Form and Instruction

IC Title:

NRMN Mentee Annual Follow-up Surverys 2017 student Cohorts

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Unchanged

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	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 %

table that charts list of burden
	Approved	Previously Approved
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.