Information Collection

Information Collection Questionnaire (Data Management System)

IC 43628 under ICR 202206-0925-001 · OMB 0925-0348.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0348 can be found here:

2026-03-27 - Reinstatement with change of a previously approved collection

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Information Collection Questionnaire (Data Management System)	Form and Instruction
1 survey instrument Attachment 1 - WTP Survey Instrument 2022- screen shots v2 (3).docx	Form and Instruction
1 survey instrument Attachment 1 - WTP Survey Instrument 2022- screen shots v2 (3).docx	Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:

Information Collection Questionnaire (Data Management System)

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: Modified

Obligation to Respond: Required to Obtain or Retain Benefits

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	survey instrument	Attachment 1 - WTP Survey Instrument 2022- screen shots v2 (3).docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Illness Prevention

Privacy Act System of Records

Title: 09-25-0036: Extramural Awards and Chartered Advisory Committees: IMPAC 2 (Grant/Contract/Cooperative Agreement/Chartered Advisory Committee Information), HHS/NIH/OER and HHS/NIH/CM

FR Citation: 67 FR 60742

Number of Respondents: 25

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	50	6	44
Annual IC Time Burden (Hours)	700	84	616
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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