Information Collection

Rachel Pearline Award Nominations (NCI)

IC 244169 under ICR 202003-0925-002 · OMB 0925-0766.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0766 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Rachel Pearline Award Nominations (NCI)	Form and Instruction
1 Nomination form Nomination Form (3).docx	Form and Instruction
Sub-Study - Rachel Pearline Award Nominations.docx Sub-study for Rachel Pearline Award Nominations	IC Document

IC Title:

Rachel Pearline Award Nominations (NCI)

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 and Instruction	1	Nomination form	Nomination Form (3).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	10	10
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Sub-study for Rachel Pearline Award Nominations	Sub-Study - Rachel Pearline Award Nominations.docx	10/20/2020

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