Information Collection

Pre & post-program survey questions for OMH Minority Leadership Development Program

IC 254400 under ICR 202206-0990-003 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
HHS Host-Site Pre-Program Questionnaire_Clean.docx	Other-HHS Host-site pre-program ques
MLP Evaluation Scripts_Clean.docx	Other-MLP Evaluation Scripts
OMH Fellow Curriculum Post-Test Evaluations_Clean.docx	Other-OMH Fellow Curriculum Post-Tes
OMH Awardee Pre-Program_Clean.docx	Other-OMH Awardee Pre-Program Survey
OMH Fellow Curriculum Pre - Test Evaluations_Clean.docx	Other-OMH Fellow Curriculum Pre-Test
OMH Fellow Pre-Program Questionaire_Clean.docx	Other-OMH Fellow Pre-Program Questio
0990-0379 MEMO_FastTrack Generic_MLDP_624.docx Memo: Pre & post-program survey questions for OMH Minority Leadership Development Program	IC Document

IC Title:

Pre & post-program survey questions for OMH Minority Leadership Development Program

Agency IC Tracking Number:

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-HHS Host-site pre-program questionnaire	Yes	Yes	Fillable Printable
Other-MLP Evaluation Scripts	No		Paper Only
Other-OMH Fellow Curriculum Post-Test Evaluations	Yes	Yes	Fillable Printable
Other-OMH Awardee Pre-Program Survey	Yes	Yes	Fillable Printable
Other-OMH Fellow Curriculum Pre-Test Evaluations	Yes	Yes	Fillable Printable
Other-OMH Fellow Pre-Program Questionnaire	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 64

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Businesses or other for-profits

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	64	64
Annual IC Time Burden (Hours)	365	365
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Memo: Pre & post-program survey questions for OMH Minority Leadership Development Program		06/27/2022

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

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