Information Collection

NMRI Survey Form

IC 238838 under ICR 201912-0925-003 · OMB 0925-0748.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0748 can be found here:

Documents and Forms

Document Name Document Type
Form 6 NMRI Survey Form Form and Instruction
6 NMRI Survey Form (6) NMRI Survey Form.pdf Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	NMRI Survey Form	Agency IC Tracking Number:

Is this a Common Form? No		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 and Instruction	6	NMRI Survey Form	(6) NMRI Survey Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: NIH Privacy Act Systems of Record 09-25-0014, âClinical Research: Student Records, HHS/NIH/OD/OIR/OE,â	FR Citation: 67 FR 60742

Number of Respondents: 800	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	800	800
Annual IC Time Burden (Hours)	400	400
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.