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⚠️ Notice: This information collection may be referencing outdated material.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 2022 HDRI Course Assessment 2022 HDRI Course Assessment (7-15-22) final.docx Form
2022 FastTrack GenClearance Customer Feedback (7-15-22) final.docx Fast track for 2022 HDRI Course Assessment 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	2022 HDRI Course Assessment	2022 HDRI Course Assessment (7-15-22) 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: 75	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	75	75
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Fast track for 2022 HDRI Course Assessment	2022 FastTrack GenClearance Customer Feedback (7-15-22) final.docx	07/18/2022

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