Nifa-19-01 Research & Related Personal Data Reviewer Form

NIFA Proposal Review Process

FINAL Revision RR_PersonalData_1_2-V1.2 Boim (003)

OMB: 0524-0041

Document [docx]
Download: docx | pdf



RESEARCH & RELATED PERSONAL DATA

Reviewer

OMB No. 0524-0041

Expiration Date:


The Federal Government has a continuing commitment to monitor the operation of its review and award processes to identify and address any inequities based on gender, race, ethnicity, or disability. Submission of the requested information is voluntary and is not a precondition of serving on the panel. However, information not submitted will seriously undermine the statistical validity, and therefore the usefulness, of information received from others. Any individual not wishing to submit some or all the information should check the box provided for this purpose. This form will not be duplicated and will only be used for ensuring that the panel includes individuals from diverse populations. This data will be kept confidential.



Shape1



Shape4 Shape2 Shape3 *First Name:

Reviewer


Shape5 Shape6 Shape7


Shape8 Shape9


Shape10


Shape11 Shape12 Gender:


Shape13 Race (check all that apply):



Shape14 Asian

Shape15 Black or African American



Ethnicity: List the state and zip code your company headquarters or university is located in. If not employed, list the state and zip code you currently reside in.

*State:


Shape16 Shape17


Shape18


Shape19












According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond

to, a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information

collection is 0524-0041. The time required to complete this information collection is estimated to average .5 hour per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.









Shape20


Shape21

File Typeapplication/vnd.openxmlformats-officedocument.wordprocessingml.document
File TitleRR_PersonalData_1_2-V1.2.pdf
Authormshim
File Modified0000-00-00
File Created2022-09-26

© 2024 OMB.report | Privacy Policy