Information Collection

Health Disparities Research Institute (HDRI) (NIMHD)

IC 249446 under ICR 202201-0925-002 · OMB 0925-0740.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0740 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Health Disparities Research Institute (HDRI) (NIMHD)	Form
1 2022HDRI application form 2022 HDRI FINAL application form clean version.docx	Form
1 2022HDRI application form 2022 HDRI FINAL application form clean version.docx	Form
2021HD_1 (1).docx email invite	IC Document
2021HD_1 (1).docx email invite	IC Document
2022HD_2.docx sub-study Health Disparities Research Institute (HDRI)	IC Document
2022HD_2.docx sub-study Health Disparities Research Institute (HDRI)	IC Document

IC Title:

Health Disparities Research Institute (HDRI) (NIMHD)

Agency IC Tracking Number:

IC Status: Modified

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	1	2022HDRI application form	2022 HDRI FINAL application form clean version.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 250

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	250	250
Annual IC Time Burden (Hours)	104	104
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
email invite	2021HD_1 (1).docx	09/22/2021
sub-study Health Disparities Research Institute (HDRI)	2022HD_2.docx	09/22/2021

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