Information Collection

Medicine: NIH Mind the Gap Webinar Series Survey II

IC 230159 under ICR 201906-0925-001 · 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⚠️ Notice: This information collection may be referencing outdated material.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 Medicine: NIH Mind the Gap Webinar Series Survey II	Form
1 MtG Customer Satisfaction Survey 2018 MtG Customer Satisfaction Survey - Survey Monkey Screenshot v2.docx	Form
Fast Track Template 2018 - Mind the Gap Evaluation_01.31.18_Clean.doc Fast track template Mind the Gap	IC Document

IC Title:

Medicine: NIH Mind the Gap Webinar Series Survey II

Agency IC Tracking Number:

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	1	MtG Customer Satisfaction Survey	2018 MtG Customer Satisfaction Survey - Survey Monkey Screenshot v2.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 300

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
	Requested	Previously Approved
Annual Number of Responses for this IC	300	300
Annual IC Time Burden (Hours)	25	25
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Fast track template Mind the Gap	Fast Track Template 2018 - Mind the Gap Evaluation_01.31.18_Clean.doc	02/16/2018

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