Information Collection

OMH Minority Leadership Development Program Post-Program Questionnaire

IC 263695 under ICR 202402-0990-005 · OMB 0990-0379.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0990-0379 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
MLDP Host Site Agency Evaluation_Updated 5.3 (OMB).docx	Other-Evaluation
MLDP Host Site Agency Evaluation_Updated 5.3 (OMB).docx	Other-Evaluation
OMH Awardee Post-Program Questionnaire (OMB).docx	Other-Questionnaire
OMH Awardee Post-Program Questionnaire (OMB).docx	Other-Questionnaire
OMH MLDP Fellow Post Program Questionaire_5.23(OMB).docx	Other-Questionnaire
OMH MLDP Fellow Post Program Questionaire_5.23(OMB).docx	Other-Questionnaire
track changes 0990-0379 MEMO_FastTrack Generic Clearance Submission Template_MLDP_060723 - Revised 021224.docx Generic Clearance for the Collection of Routine Customer Feedback” HHS Online Customer Surveys	IC Document
track changes 0990-0379 MEMO_FastTrack Generic Clearance Submission Template_MLDP_060723 - Revised 021224.docx Generic Clearance for the Collection of Routine Customer Feedback” HHS Online Customer Surveys	IC Document

IC Title:

OMH Minority Leadership Development Program Post-Program Questionnaire

Agency IC Tracking Number:

IC Status: Unchanged

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Other-Evaluation	MLDP Host Site Agency Evaluation_Updated 5.3 (OMB).docx	Yes	Yes	Fillable Printable
Other-Questionnaire	OMH Awardee Post-Program Questionnaire (OMB).docx	Yes	Yes	Fillable Printable
Other-Questionnaire	OMH MLDP Fellow Post Program Questionaire_5.23(OMB).docx	Yes	Yes	Fillable Printable

Line of Business: Health

Subfunction: Consumer Health and Safety

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 49

Number of Respondents for Small Entity: 0

Affected Public: Federal Government

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Requested	Previously Approved
Annual Number of Responses for this IC	49	49
Annual IC Time Burden (Hours)	273	273
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Generic Clearance for the Collection of Routine Customer Feedbackâ HHS Online Customer Surveys	track changes 0990-0379 MEMO_FastTrack Generic Clearance Submission Template_MLDP_060723 - Revised 021224.docx	02/12/2024

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