Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 11 NIH NHMA Feedback Form	Form and Instruction	New	Available
Form 10 NIH NHMA Academic Career Fellow Travel Awards Application	Form and Instruction	New	Available
Form 9 NIH NMA Feedbacl Form	Form and Instruction	New	Available
Form 8 NIH NMA Academic Career Fellow Travel Awards Application	Form and Instruction	New	Available
Form 7 NMRI Mentor-Mentee Agreement Form	Form and Instruction	New	Available
Form 6 NMRI Survey Form	Form and Instruction	New	Available
Form 5 NMRI Evaluation Form	Form and Instruction	New	Available
Form 4 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	New	Repair queued
Form 3 DSTRP Feedback Form	Form and Instruction	New	Available
Form 2 STEP-UP Student Feedback Form	Form and Instruction	New	Available
Form 1 Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	Form and Instruction	New	Available
Form 12 NIDDK/NHMA Feedback Form	Form and Instruction	Removed	Available
Form 11 NHMA Application Form	Form and Instruction	Removed	Available
Form 10 NIH-NMA Feedback Form	Form and Instruction	Removed	Available
Form 9 NIH-NMA Fellows Program on Careers in Academic Medicine Application	Form and Instruction	Removed	Available
Form 8 NMRI Mentor-Mentee Agreement Forms	Form and Instruction	Removed	Available
Form 7 NMRI Survey	Form and Instruction	Removed	Available
Form 6 NMRI Meeting Evaluation Form	Form and Instruction	Removed	Available
Form 5 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	Removed	Available
Form 4 DSRTP Feedback Form	Form and Instruction	Removed	Available
Form 3 Diversity Summer Research Training Program (DSRTP) Application	Form and Instruction	Removed	Available
Form 2 STEP-UP High School and Undergraduate Feedback Form	Form and Instruction	Removed	Available
Form 1 Short-Term Research Experience for Underrepresented Persons (STEP-UP)	Form and Instruction	Removed	Available
2019-27514.pdf	Supplementary Document	Uploaded 2019-12-20	Available
(13) PIA NIDDK On Site Web Apps.pdf	Supplementary Document	Uploaded 2019-12-09	Available
(12) Privacy Act Notification Memo.pdf	Supplementary Document	Uploaded 2019-12-09	Available
2019 OMHRC Supporting Statement A Final 2019.12.09.docx	Supporting Statement A	Uploaded 2019-12-09	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
238843	NIH/NHMA Feedback Form	Form and Instruction	New	NIH NHMA Feedback Form
238842	NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	Form and Instruction	New	NIH NHMA Academic Career Fellow Travel Awards Application
238841	NIH/NMA Feedback Form	Form and Instruction	New	NIH NMA Feedbacl Form
238840	NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	Form and Instruction	New	NIH NMA Academic Career Fellow Travel Awards Application
238839	NMRI Mentor-Mentee Agreement Form	Form and Instruction	New	NMRI Mentor-Mentee Agreement Form
238838	NMRI Survey Form	Form and Instruction	New	NMRI Survey Form
238837	NMRI Evaluation Form	Form and Instruction	New	NMRI Evaluation Form
238836	Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	New	Network of Minority Health Research Investigators (NMRI) Enrollment Form
238835	Diversity Summer Research Training Program (DSTRP) Feedback Form	Form and Instruction	New	DSTRP Feedback Form
238834	STEP-UP Student Feedback Form	Form and Instruction	New	STEP-UP Student Feedback Form
238833	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	Form and Instruction	New	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application
222877	NIDDK/NHMA Feedback Form	Form and Instruction	Removed	NIDDK/NHMA Feedback Form
222876	NIH/NHMA Fellows Program Application	Form and Instruction	Removed	NHMA Application Form
222875	NIH/NMA Feedback Form	Form and Instruction	Removed	NIH-NMA Feedback Form
222874	NIH/NMA Fellows Program on Careers in Academic Medicine Application	Form and Instruction	Removed	NIH-NMA Fellows Program on Careers in Academic Medicine Application
222873	NMRI Mentor/Mentee Agreement Forms	Form and Instruction	Removed	NMRI Mentor-Mentee Agreement Forms
222872	NMRI Survey Form	Form and Instruction	Removed	NMRI Survey
222871	NMRI Evaluation Form	Form and Instruction	Removed	NMRI Meeting Evaluation Form
222870	Network of Minority Research Invetigators (NMRI) Enrollment Form	Form and Instruction	Removed	Network of Minority Health Research Investigators (NMRI) Enrollment Form
222868	DSRTP Feedback Form	Form and Instruction	Removed	DSRTP Feedback Form
222867	Diversity Summer Research Training Program (DSRTP) Application	Form and Instruction	Removed	Diversity Summer Research Training Program (DSRTP) Application
222866	STEP-UP Student Feedback Form	Form and Instruction	Removed	STEP-UP High School and Undergraduate Feedback Form
222865	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	Form and Instruction	Removed	Short-Term Research Experience for Underrepresented Persons (STEP-UP)

ICR Details

OMB Control No: 0925-0748	ICR Reference No: 201912-0925-003
Status: Historical Active	Previous ICR Reference No: 201608-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 02/07/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 12/23/2019
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	02/28/2023	36 Months From Approved	02/29/2020
Responses	3,914	0	4,320
Time Burden (Hours)	2,291	0	2,569
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection activity is necessary to determine the eligibility and quality of potential awardees for traineeships and mentorships in the National Institute of Diabetes and Digestive and Kidney Diseases’ Office of Minority Health Research Coordination programs.

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Authorizing Statute(s): US Code: 42 USC 241 and 282(b)(13) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 55318	10/16/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 70200	12/20/2019
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 11

table that charts list of burden

IC Title	Form No.	Form Name
DSRTP Feedback Form	4	DSRTP Feedback Form
Diversity Summer Research Training Program (DSRTP) Application	3	Diversity Summer Research Training Program (DSRTP) Application
Diversity Summer Research Training Program (DSTRP) Feedback Form	3	DSTRP Feedback Form
NIDDK/NHMA Feedback Form	12	NIDDK/NHMA Feedback Form
NIH/NHMA Feedback Form	11	NIH NHMA Feedback Form
NIH/NHMA Fellows Program Application	11	NHMA Application Form
NIH/NMA Feedback Form	10	NIH-NMA Feedback Form
NIH/NMA Feedback Form	9	NIH NMA Feedbacl Form
NIH/NMA Fellows Program on Careers in Academic Medicine Application	9	NIH-NMA Fellows Program on Careers in Academic Medicine Application
NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	10	NIH NHMA Academic Career Fellow Travel Awards Application
NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	8	NIH NMA Academic Career Fellow Travel Awards Application
NMRI Evaluation Form	6	NMRI Meeting Evaluation Form
NMRI Evaluation Form	5	NMRI Evaluation Form
NMRI Mentor-Mentee Agreement Form	7	NMRI Mentor-Mentee Agreement Form
NMRI Mentor/Mentee Agreement Forms	8	NMRI Mentor-Mentee Agreement Forms
NMRI Survey Form	6	NMRI Survey Form
NMRI Survey Form	7	NMRI Survey
Network of Minority Health Research Investigators (NMRI) Enrollment Form	4	Network of Minority Health Research Investigators (NMRI) Enrollment Form
Network of Minority Research Invetigators (NMRI) Enrollment Form	5	Network of Minority Health Research Investigators (NMRI) Enrollment Form
STEP-UP Student Feedback Form	2	STEP-UP High School and Undergraduate Feedback Form
STEP-UP Student Feedback Form	2	STEP-UP Student Feedback Form
Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	1	Short-Term Research Experience for Underrepresented Persons (STEP-UP)
Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	1	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,914	4,320	0	-406	0	0
Annual Time Burden (Hours)	2,291	2,569	0	-278	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: Yes

Burden Reduction Due to: Miscellaneous Actions

Short Statement: Most changes to the questions in the forms are only minor changes to reflect the change in speakers and presentation titles (topics) at the programs’ annual events. A few questions on the forms were reworded to improve clarity. A few questions were removed as they were deemed unnecessary by new staff who have since replaced staff who managed OMHRC programs at the time of the 2016 submission. The DSRTP application form (found in 2016 submission) which was housed on a NIDDK website will no longer be used. Instead, beginning in November 2019, applicants will be redirected to the NIH Office of Intramural Training and Education (OITE) Summer Internship Program (SIP) website: https://www2.training.nih.gov/apps/publicForms/sip/forms/message.aspx?strMessage=sacc and apply through the SIP application and select DSRTP as a subprogram in the application portal. OITE SIP holds its own approved OMB project clearance under “NIH Office of Intramural Training and Education Application (OD),” OMB Control Number 0925-0299, Expiration date: 6/30/2022. Thus, the DSRTP application form was removed from the current submission. The NIH/NHMA Academic Career Fellow Travel Awards application is now available in an online submission format. In 2016, the application was an electronic form that was completed and emailed to an OMHRC staff person. The NHMA program application form mirrors the NIH/NMA Academic Career Fellow Travel Awards application which was approved in 2016 and has no changes. The same database portal is used for both program applications and continues to be reviewed under the same Privacy Impact Assessment (see Attachment 13). In the A12-1 Burden Table, the estimated number of respondents has changed since 2016 for some of the forms as the number of applicants/participants of OMHRC programs have grown or waned since 2016. Correspondingly, the total annual burden hours and annualized costs to respondents changes in comparison to the earlier 2016 submission.

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Annual Cost to Federal Government: $155,973

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 12/23/2019

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