Form 1 Traveling Exhibition Host Venue survey

NLM Traveling Exhibition Host Venue
Report
OMB Control Number: 0925-0766
Expiration Date: 04/2023
Public reporting burden for this collection of information is estimated to average 15 minutes 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. An agency may not conduct or sponsor, and a person is not required to respond to,
a collection of information unless it displays a current valid OMB control number. Send
comments regarding this burden estimate or any other aspect of this collection of information,
including suggestions for reducing this burden, to NIH, Project Clearance Branch, 6705
Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0766). Do not return
the completed form to this address.
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Thank you for hosting an NLM Traveling Exhibition. Please share your successful hosting
experience about visitors and activities using this online host venue report. We ask that you
submit the report within 2 weeks of the end of your booking period.
* Required
* This form will record your name, please fill your name.

Host Venue Information
1. Contact Name *

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NLM Traveling Exhibition Host Venue Report

2. Organization *

3. Email *

4. Phone number *

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Traveling Exhibition Display and Visitors
5. Traveling Exhibition Title

6. Exhibition Display Opening Date: *
Please input date (M/d/yyyy)

7. Exhibition Display Closing Date *
Please input date (M/d/yyyy)

8. Total Number of Exhibition Visitors *

9. Visitor Counting Method *
Actual Count
20% of Gate Count

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Activities while Hosting the Exhibition
10. If you had any programs and events as part of hosting the traveling
exhibition, please provide a summary below.

11. Total Number of Activity Attendees or Participants

12. Please let us know, if any programs or events introduced to
visitors/attendees NLM health information resources such as (mark all
that apply):
MedlinePlus
MedlinePlus en Español
PubMed
PubMed Central
ClinicalTrials.gov
Other

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13. Please tell us if you worked with a Regional Medical Library (RML) for
programming activities related to hosting the exhibition.
No, we did not work with an RML.
Yes, we worked with our RML

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Additional Comments
14. Please share any other details or comments below.

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