Information Collection

National Institute of Mental Health (NIMH) Core Facility User Survey

IC 231930 under ICR 201802-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 National Institute of Mental Health (NIMH) Core Facility User Survey	Form
1 NIMH Core User Survey template NIMH Core User Survey Template 6.21.2018.docx	Form
Request for OMB Clearance - Collection of Routine Customer Feedback (NIMH Core Facility User Survey2).docx National Institute of Mental Health (NIMH) Core Facility User Survey fast track	IC Document

IC Title:

National Institute of Mental Health (NIMH) Core Facility User Survey

Agency IC Tracking Number:

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	1	NIMH Core User Survey template	NIMH Core User Survey Template 6.21.2018.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 85

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits, Not-for-profit institutions

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	85	85
Annual IC Time Burden (Hours)	9	9
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
National Institute of Mental Health (NIMH) Core Facility User Survey fast track	Request for OMB Clearance - Collection of Routine Customer Feedback (NIMH Core Facility User Survey2).docx	06/25/2018

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.