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 NMA Academic Career Development Workshop Contact Info and Feedback	Form and Instruction	New	Repair queued
Form 3 STEP-UP Participant survey form	Form and Instruction	New	Available
Form 13 NIH NHMA Feedback Form	Form and Instruction	Modified	Available
Form 12 NIH NHMA Academic Career Fellow Travel Awards Application	Form and Instruction	Modified	Available
Form 10 NIH NMA Feedbacl Form	Form and Instruction	Modified	Available
Form 9 NIH NMA Academic Career Fellow Travel Awards Application	Form and Instruction	Modified	Available
Form 8 NMRI Mentor-Mentee Agreement Form	Form and Instruction	Modified	Available
Form 7 NMRI Survey Form	Form and Instruction	Modified	Available
Form 6 NMRI Evaluation Form	Form and Instruction	Modified	Available
Form 5 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	Modified	Available
Form 4 DSTRP Feedback Form	Form and Instruction	Modified	Available
Form 2 STEP-UP Student Feedback Form	Form and Instruction	Modified	Available
Form 1 Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	Form and Instruction	Unchanged	Available
pub 30-day FRN 2020-09693.pdf	Supplementary Document	Uploaded 2020-05-20	Available
OMHRC Supporting Statement A 2020.05.20 Final.docx	Supporting Statement A	Uploaded 2020-05-20	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

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
241916	NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	Form and Instruction	New	NMA Academic Career Development Workshop Contact Info and Feedback
241914	STEP-UP Participant Survey form	Form and Instruction	New	STEP-UP Participant survey form
238843	NIH/NHMA Feedback Form	Form and Instruction	Modified	NIH NHMA Feedback Form
238842	NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Modified	NIH NHMA Academic Career Fellow Travel Awards Application
238841	NIH/NMA Feedback Form	Form and Instruction	Modified	NIH NMA Feedbacl Form
238840	NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Modified	NIH NMA Academic Career Fellow Travel Awards Application
238839	NMRI Mentor-Mentee Agreement Form	Form and Instruction	Modified	NMRI Mentor-Mentee Agreement Form
238838	NMRI Survey Form	Form and Instruction	Modified	NMRI Survey Form
238837	NMRI Evaluation Form	Form and Instruction	Modified	NMRI Evaluation Form
238836	Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	Modified	Network of Minority Health Research Investigators (NMRI) Enrollment Form
238835	Diversity Summer Research Training Program (DSTRP) Feedback Form	Form and Instruction	Modified	DSTRP Feedback Form
238834	STEP-UP Student Feedback Form	Form and Instruction	Modified	STEP-UP Student Feedback Form
238833	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	Form and Instruction	Unchanged	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application

ICR Details

OMB Control No: 0925-0748	ICR Reference No: 202005-0925-001
Status: Historical Active	Previous ICR Reference No: 201912-0925-003
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: 08/14/2020
Retrieve Notice of Action (NOA)	Date Received in OIRA: 05/21/2020
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	36 Months From Approved	02/28/2023
Responses	7,114	0	3,914
Time Burden (Hours)	2,557	0	2,291
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:
	85 FR 26980	05/06/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

table that charts list of burden

IC Title	Form No.	Form Name
Diversity Summer Research Training Program (DSTRP) Feedback Form	4	DSTRP Feedback Form
NIH/NHMA Feedback Form	13	NIH NHMA Feedback Form
NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	11	NMA Academic Career Development Workshop Contact Info and Feedback
NIH/NMA Feedback Form	10	NIH NMA Feedbacl Form
NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	12	NIH NHMA Academic Career Fellow Travel Awards Application
NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	9	NIH NMA Academic Career Fellow Travel Awards Application
NMRI Evaluation Form	6	NMRI Evaluation Form
NMRI Mentor-Mentee Agreement Form	8	NMRI Mentor-Mentee Agreement Form
NMRI Survey Form	7	NMRI Survey Form
Network of Minority Health Research Investigators (NMRI) Enrollment Form	5	Network of Minority Health Research Investigators (NMRI) Enrollment Form
STEP-UP Participant Survey form	3	STEP-UP Participant survey 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) 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	7,114	3,914	0	3,200	0	0
Annual Time Burden (Hours)	2,557	2,291	0	266	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: No

Burden Reduction Due to:

Short Statement: This is a revision to an existing collection in use under OMB Control Number 0925-0748, expiring 2/28/2023. The OMHRC is adding two additional instruments. The first instrument (Section A12, Attachment 11) is a previously approved information collection request under OMB# 0925-0648, expiration date: 05/2021, “Generic Clearance for the Collection of Routine Customer Feedback,” titled “NIH/National Medical Association (NMA) Academic Career Development Workshop Contact Information and Feedback Form.” The purpose is to update contact information and obtain feedback from past recipients of the NIH/NMA Travel Awards program and past participants of the NIH/NMA Academic Career Development Workshop. While the OMHRC originally intended it to be a one-time collection, they have decided to change it to a regular, annual collection to capture informative programmatic feedback and contact information for future program participants.

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Annual Cost to Federal Government: $160,517

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? No

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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: 05/21/2020

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