Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 Health Disparities Research Institute (HDRI) Course Assessment (NIMHD) Form
1 2021 HDRI Course Assessment survey 2021 HDRI Course Assessment (6-30-21) final.docx Form
Save the Date 2021 Health Disparities Research Institute.msg save the date IC Document
2021 Fast Track Generic Clearance for Customer Feedback (7-8-21) Revised 4.docx Health Disparities Research Institute (HDRI) Course Assessment (NIMHD) IC Document

Information Collection (IC) Details

IC Title:	Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)	Agency IC Tracking Number:

IC Status: Unchanged

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	1	2021 HDRI Course Assessment survey	2021 HDRI Course Assessment (6-30-21) final.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 65	Number of Respondents for Small Entity: 0

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

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	65	65
Annual IC Time Burden (Hours)	11	11
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
save the date	Save the Date 2021 Health Disparities Research Institute.msg	07/12/2021
Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)	2021 Fast Track Generic Clearance for Customer Feedback (7-8-21) Revised 4.docx	07/12/2021

Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.