Information Collection

Inform NIH About Harassment or Discrimination Concerns

IC 255943 under ICR 202209-0925-002 · OMB 0925-0777.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0777 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Inform NIH About Harassment or Discrimination Concerns	Form and Instruction
1 Harassment web form att 1 Harassment web form.docx	Form and Instruction
1 NIH Harassment Webform rev NIH Harassment webform 03 08 2023.docx	Form and Instruction

IC Title:

Inform NIH About Harassment or Discrimination Concerns

Agency IC Tracking Number:

Is this a Common Form? No

IC Status: New

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	NIH Harassment Webform	rev NIH Harassment webform 03 08 2023.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 240

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions, 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	240	240
Annual IC Time Burden (Hours)	60	60
Annual IC Cost Burden (Dollars)	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.