Information Collection

NIH 6710B Change Readiness Survey (OD/ORS)

IC 242896 under ICR 202104-0925-001 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 NIH 6710B Change Readiness Survey (OD/ORS)	Form and Instruction
1 6710B Change Readiness Survey 07292020-6710B_ChangeReadinessSurvey_Online.pdf	Form and Instruction
1 6710B Change Readiness Survey 07292020-6710B_ChangeReadinessSurvey_Online.pdf	Form and Instruction
072720-OMB Request_ 6710B_Change Readiness Survey.docx 6710 Change Readiness Survey Fast track	IC Document
072720-OMB Request_ 6710B_Change Readiness Survey.docx 6710 Change Readiness Survey Fast track	IC Document

IC Title:

NIH 6710B Change Readiness Survey (OD/ORS)

Agency IC Tracking Number:

IC Status: Unchanged

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	6710B Change Readiness Survey	07292020-6710B_ChangeReadinessSurvey_Online.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 150

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
6710 Change Readiness Survey Fast track	072720-OMB Request_ 6710B_Change Readiness Survey.docx	07/30/2020

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