Input Survey for DEBUT Program (NIBIB)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	Input Survey for DEBUT Program (NIBIB)	Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.