GRR Submission Form - ANA Reviewer Profile

Request for Approval under the “Generic Clearance for the Collection of Grant

Reviewer Recruiter Forms” (OMB Control Number: 0970-0477)

TITLE OF INFORMATION:
ANA Panel Reviewer Profile Questionnaire
PURPOSE:

To collect basic information relevant to selecting reviewers and chairpersons to serve for ANA's Objec
DESCRIPTION OF RESPONDENTS:

Members of the public who are experienced professionals and possess subject matter expertise and q
CERTIFICATION:
I certify the following to be true:
1. The collection is voluntary.
2. The collection is low-burden for respondents and low-cost for the Federal Government.
3. The collection is non-controversial and does not raise issues of concern to other federal
agencies.
4. The results are not intended to be disseminated to the public.
5. Information gathered will not be used for the purpose of substantially informing influential
policy decisions.
6. The collection is targeted to the solicitation of opinions from respondents who have
experience with the program or may have experience with the program in the future.
Kim Romine, ANA
Name:________________________________________________

BURDEN HOURS (Annual Bases)
Category of Respondent

No. of
Participation
Respondents Time

Burden

First-time respondents

75

.5 hours

37.5 hours

Previous respondents

225

.25 hours

56.25 hours

Totals

300

93.75 hours

0
FEDERAL COST: The estimated annual cost to the Federal government is ____________

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Administration of the Instrument
1. How will you collect the information? (Check all that apply)
Web-based or other forms of Social Media
Telephone
In-person
Mail
■ Other, Explain
Fillable PDF form, sent via e-mail

Please make sure that all instruments, instructions, and scripts are submitted with the
request.

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