Information Collection

Input Survey for DEBUT Program (NIBIB)

IC 241308 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⚠️ Notice: This information collection may be referencing outdated material.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 Input Survey for DEBUT Program (NIBIB)	Form
1 DEBUT survey DEBUT survey_Final (1).docx	Form
NIBIB_Collection of Qualitative Feedback_DEBUT_Final Rev.docx DEBUT fast track request	IC Document

IC Title:

Input Survey for DEBUT Program (NIBIB)

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	DEBUT survey	DEBUT survey_Final (1).docx		No		Paper Only

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 200

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 0 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	33	33
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
DEBUT fast track request	NIBIB_Collection of Qualitative Feedback_DEBUT_Final Rev.docx	04/10/2020

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