Information Collection

Self-Nomination Form for the NICHD OHE Internal Advisory Committee (NICHD)

IC 262223 under ICR 202307-0925-004 · OMB 0925-0766.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Self Nomination Form Self-Nomination Form for the NICHD OHE Internal Advisory Committee (NICHD)	Form
1 Self Nomination Form Self-Nomination Form.pdf	Form
Self Nomination NICHD.docx Template	IC Document
Self Nomination EMAILS.docx Email Correspondence	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service

FR Citation: 83 FR 6591

Number of Respondents: 46

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	46	46
Annual IC Time Burden (Hours)	15	15
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template		09/18/2023
Email Correspondence		09/18/2023

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

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