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

Document Name Document Type
Form 1 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

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Self-Nomination Form for the NICHD OHE Internal Advisory Committee (NICHD)	Agency IC Tracking Number:

IC Status: New

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	Self Nomination Form	Self-Nomination Form.pdf		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 %

	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

Title	Document	Date Uploaded
Template	Self Nomination NICHD.docx	09/18/2023
Email Correspondence	Self Nomination EMAILS.docx	09/18/2023

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