Diversity Supplement Feedback Survey (NCCIH)

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⚠️ Notice: This information collection may be referencing outdated material.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 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

Information Collection (IC) Details

IC Title:	Diversity Supplement Feedback Survey (NCCIH)	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	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 %

	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
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.