Information Collection

2018-2021 NIEHS DERT Grantee Survey

IC 233074 under ICR 201807-0925-003 · OMB 0925-0657.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 2018-2021 NIEHS DERT Grantee Survey	Form and Instruction
1 2018-2021 NIEHS DERT Grantee Survey Attachment A 2018-2021 NIEHS DERT Grantee Survey.docx	Form and Instruction

IC Title:

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Required to Obtain or Retain Benefits

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	1	2018-2021 NIEHS DERT Grantee Survey	Attachment A 2018-2021 NIEHS DERT Grantee Survey.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 1,400

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 90 %

table that charts list of burden
	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	1,400	1,400
Annual IC Time Burden (Hours)	700	700
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.