STEP-UP Participant Survey form

Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0748 can be found here:

Documents and Forms

Document Name Document Type
Form 1 STEP-UP Participant Survey form Form and Instruction
1 Survey (3) STEP-UP Participant Survey Form.pdf Form and Instruction
1 Survey (3) STEP-UP Participant Survey Form.pdf Form and Instruction

Information Collection (IC) Details

IC Title:	STEP-UP Participant Survey form	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	1	Survey	(3) STEP-UP Participant Survey Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09-25-0014 Clinical Research: Student Records, HHS/NIH/OD/OIR/OE	FR Citation: 67 FR 60741

Number of Respondents: 2,200	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Previously Approved
Annual Number of Responses for this IC	2,200	2,200
Annual IC Time Burden (Hours)	183	183
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.