Mentored Mock Review – Participant Feedback (NCI)

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

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0642 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Mentored Mock Review – Participant Feedback (NCI) Form
1 MMR survey MMR Survey Screenshots.pdf Form
Fast Track Sub-Study CRCHD MMR.docx Fast track sub-study CRCHD MMR IC Document
MMR Email invite.docx MMR email invite IC Document

Information Collection (IC) Details

IC Title:	Mentored Mock Review – Participant Feedback (NCI)	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	MMR survey	MMR Survey Screenshots.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	5	5
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast track sub-study CRCHD MMR	Fast Track Sub-Study CRCHD MMR.docx	05/27/2020
MMR email invite	MMR Email invite.docx	05/27/2020

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