Information Collection

Diversity Supplement Feedback Survey (NCCIH)

IC 255764 under ICR 202307-0925-002 · OMB 0925-0648.

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Diversity Supplement Feedback Survey (NCCIH)	Form
1 screenshot NCCIH Diversity Supplement Scholar Diversity Supplement Scholar_survey instrument.docx	Form
Diversity Survey _Oureach Email Invites and Reminders.docx email invite	IC Document
Fast Track Template_Survey_Diversity Supplement Scholars.docx fast track for Diversity Supplement Scholars	IC Document

IC Title:

Diversity Supplement Feedback Survey (NCCIH)

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	URL	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form	1	screenshot NCCIH Diversity Supplement Scholar	Diversity Supplement Scholar_survey instrument.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: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	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

table that charts IC Documents
Title	Document	Date Uploaded
email invite	Diversity Survey _Oureach Email Invites and Reminders.docx	09/07/2022
fast track for Diversity Supplement Scholars	Fast Track Template_Survey_Diversity Supplement Scholars.docx	09/12/2022

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