Information Collection

2023 Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)

IC 259872 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⚠️ Notice: This information collection may be referencing outdated material.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 2023 Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)	Form and Instruction
1 Survey 2023 HDRI Course Assessment (4-26-23).docx	Form and Instruction
2023 FastTrack GenClearance Customer Feedback (4-26-23) Final.docx Template	IC Document
NIMHD listserv and Social Media Announcements.docx Announcements	IC Document

IC Title:

2023 Health Disparities Research Institute (HDRI) Course Assessment (NIMHD)

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 and Instruction	1	Survey	2023 HDRI Course Assessment (4-26-23).docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 50

Number of Respondents for Small Entity: 0

Affected Public: Private Sector

Private Sector: Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	50	50
Annual IC Time Burden (Hours)	8	8
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template	2023 FastTrack GenClearance Customer Feedback (4-26-23) Final.docx	04/26/2023
Announcements	NIMHD listserv and Social Media Announcements.docx	04/26/2023

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