Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 1 Evaluation	Form	Modified	Available
Form 1 Evaluation Form	Form and Instruction	Modified	Available
Form 1 NMRI Evaluation Form Day 3	Form and Instruction	Modified	Repair queued
Form 1 Evaluation	Form	Modified	Available
Form 1 Evaluation Form	Form and Instruction	Modified	Available
Form 1 NMRI Evaluation Form Day 2	Form and Instruction	Modified	Repair queued
Form 1 Form	Form and Instruction	Unchanged	Available
Form 1 NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	Form and Instruction	Unchanged	Repair queued
Form 1 Survey	Form and Instruction	Unchanged	Available
Form 1 STEP-UP Participant Survey form	Form and Instruction	Unchanged	Repair queued
Form 1 Feedback Form	Form and Instruction	Unchanged	Available
Form 1 NIH/NHMA Feedback Form	Form and Instruction	Unchanged	Repair queued
Form 1 Application	Form and Instruction	Unchanged	Available
Form 1 NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Unchanged	Repair queued
Form 1 Feedback Form	Form and Instruction	Unchanged	Available
Form 1 NIH/NMA Feedback Form	Form and Instruction	Unchanged	Available
Form 1 Application	Form and Instruction	Unchanged	Available
Form 1 NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Unchanged	Repair queued
Form 1 Agreement Form	Form and Instruction	Unchanged	Available
Form 1 NMRI Mentor-Mentee Agreement Form	Form and Instruction	Unchanged	Available
Form 1 Survey	Form and Instruction	Unchanged	Available
Form 1 NMRI Survey Form	Form and Instruction	Unchanged	Repair queued
Form 1 Evaluation	Form	Modified	Available
Form 1 NMRI Evaluation Form Day 1	Form	Modified	Repair queued
Form 1 Enrollment Form	Form and Instruction	Unchanged	Available
Form 1 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	Unchanged	Repair queued
Form 4 DSTRP Feedback Form	Form and Instruction	Unchanged	Available
Form 4 Diversity Summer Research Training Program (DSTRP) Feedback Form	Form and Instruction	Unchanged	Repair queued
Form 2 STEP-UP Student Feedback Form	Form and Instruction	Unchanged	Available
Form 2 STEP-UP Student Feedback Form	Form and Instruction	Unchanged	Repair queued
Form 1 Application	Form and Instruction	Unchanged	Available
Form 1 Short-Term Research Experience Program to Unlock Potential (STEP-UP) Application	Form and Instruction	Unchanged	Repair queued
(8) NMRI Evaluation form Day 3 - Original with strikethrough.docx	Supplementary Document	Uploaded 2024-06-05	Available
(8) NMRI Evaluation form Day 3 - Original with strikethrough.docx	Supplementary Document	Uploaded 2024-06-05	Missing upstream
(7) NMRI Evaluation form Day 2 - Original with strikethrough.docx	Supplementary Document	Uploaded 2024-06-05	Available
(7) NMRI Evaluation form Day 2 - Original with strikethrough.docx	Supplementary Document	Uploaded 2024-06-05	Repair queued
(6) NMRI Evaluation form Day 1 - Original with Strikethrough.docx	Supplementary Document	Uploaded 2024-06-05	Available
(6) NMRI Evaluation form Day 1 - Original with Strikethrough.docx	Supplementary Document	Uploaded 2024-06-05	Available
NIDDK OMHRC Change Memo 0925-0748.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-06-05	Available
NIDDK OMHRC Change Memo 0925-0748.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2024-06-05	Repair queued
(17) National-Institutes-of-Health-9724-PIA-03-10-2023-205.pdf	Supplementary Document	Uploaded 2023-06-12	Available
(17) National-Institutes-of-Health-9724-PIA-03-10-2023-205.pdf	Supplementary Document	Uploaded 2023-06-12	Repair queued
(16) Approved Privacy Memo NIDDK OMHRC Research Training and Mentor Programs Applications.pdf	Supplementary Document	Uploaded 2023-06-12	Available
(16) Approved Privacy Memo NIDDK OMHRC Research Training and Mentor Programs Applications.pdf	Supplementary Document	Uploaded 2023-06-12	Available
OMHRC Supporting Statement A.docx	Supporting Statement A	Uploaded 2023-06-12	Available
OMHRC Supporting Statement A.docx	Supporting Statement A	Uploaded 2023-06-12	Repair queued
NIDDK 30 day notice.pdf	Supplementary Document	Uploaded 2023-06-09	Available
NIDDK 30 day notice.pdf	Supplementary Document	Uploaded 2023-06-09	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
260465	NMRI Evaluation Form Day 3	Form	Modified	Evaluation
260465	NMRI Evaluation Form Day 3	Form and Instruction	Modified	Evaluation Form
260465	NMRI Evaluation Form Day 3	Form and Instruction	Modified
260464	NMRI Evaluation Form Day 2	Form	Modified	Evaluation
260464	NMRI Evaluation Form Day 2	Form and Instruction	Modified	Evaluation Form
260464	NMRI Evaluation Form Day 2	Form and Instruction	Modified
241916	NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	Form and Instruction	Unchanged	Form
241916	NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	Form and Instruction	Unchanged
241914	STEP-UP Participant Survey form	Form and Instruction	Unchanged	Survey
241914	STEP-UP Participant Survey form	Form and Instruction	Unchanged
238843	NIH/NHMA Feedback Form	Form and Instruction	Unchanged	Feedback Form
238843	NIH/NHMA Feedback Form	Form and Instruction	Unchanged
238842	NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Unchanged	Application
238842	NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Unchanged
238841	NIH/NMA Feedback Form	Form and Instruction	Unchanged	Feedback Form
238841	NIH/NMA Feedback Form	Form and Instruction	Unchanged
238840	NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Unchanged	Application
238840	NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	Form and Instruction	Unchanged
238839	NMRI Mentor-Mentee Agreement Form	Form and Instruction	Unchanged	Agreement Form
238839	NMRI Mentor-Mentee Agreement Form	Form and Instruction	Unchanged
238838	NMRI Survey Form	Form and Instruction	Unchanged	Survey
238838	NMRI Survey Form	Form and Instruction	Unchanged
238837	NMRI Evaluation Form Day 1	Form	Modified	Evaluation
238837	NMRI Evaluation Form Day 1	Form	Modified
238836	Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	Unchanged	Enrollment Form
238836	Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction	Unchanged
238835	Diversity Summer Research Training Program (DSTRP) Feedback Form	Form and Instruction	Unchanged	DSTRP Feedback Form
238835	Diversity Summer Research Training Program (DSTRP) Feedback Form	Form and Instruction	Unchanged
238834	STEP-UP Student Feedback Form	Form and Instruction	Unchanged	STEP-UP Student Feedback Form
238834	STEP-UP Student Feedback Form	Form and Instruction	Unchanged
238833	Short-Term Research Experience Program to Unlock Potential (STEP-UP) Application	Form and Instruction	Unchanged	Application
238833	Short-Term Research Experience Program to Unlock Potential (STEP-UP) Application	Form and Instruction	Unchanged

ICR Details

OMB Control No: 0925-0748	ICR Reference No: 202405-0925-002
Status: Historical Active	Previous ICR Reference No: 202305-0925-005
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 06/06/2024
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/05/2024
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	07/31/2026	07/31/2026	07/31/2026
Responses	5,929	0	5,929
Time Burden (Hours)	1,649	0	1,649
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection activity is necessary to determine the eligibility and quality of potential awardees for traineeships and mentorships in the National Institute of Diabetes and Digestive and Kidney Diseases’ Office of Minority Health Research Coordination programs. This will be a revision of an existing clearance submission that has a current expiration date of 08/31/2023. Since the last revision occurred there have been no major changes made to the program, but the following activities have occurred: For the Network of Minority Health Research Investigators (NMRI) survey an internal data report was created but no changes were proposed based on its findings; For the NMRI Evaluation form this was split into three documents, one for each day of workshop evaluation, but the questions remain the same from the last revision; For the National Medical Association (NMA) and National Hispanic Medical Association (NHMA) feedback forms some participant suggestions are incorporated into the NMA Career development workshop.

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Authorizing Statute(s): US Code: 42 USC 241 and 282(b)(13) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 15423	03/13/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 37077	06/06/2023
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 15

table that charts list of burden

IC Title	Form No.	Form Name
Diversity Summer Research Training Program (DSTRP) Feedback Form	4	DSTRP Feedback Form
NIH/NHMA Feedback Form	1	Feedback Form
NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	1	Form
NIH/NMA Feedback Form	1	Feedback Form
NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	1	Application
NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	1	Application
NMRI Evaluation Form Day 1	1	Evaluation
NMRI Evaluation Form Day 2	1, 1	Evaluation Form ,   Evaluation
NMRI Evaluation Form Day 3	1, 1	Evaluation Form ,   Evaluation
NMRI Mentor-Mentee Agreement Form	1	Agreement Form
NMRI Survey Form	1	Survey
Network of Minority Health Research Investigators (NMRI) Enrollment Form	1	Enrollment Form
STEP-UP Participant Survey form	1	Survey
STEP-UP Student Feedback Form	2	STEP-UP Student Feedback Form
Short-Term Research Experience Program to Unlock Potential (STEP-UP) Application	1	Application

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	5,929	5,929	0	0	0	0
Annual Time Burden (Hours)	1,649	1,649	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: OMHRC changed the name of Short-Term Research Experience for Underrepresented Persons (STEP-UP) to the Short-Term Research Experience Program to Unlock Potential. The name change was made after guidance received from the Office of General Counsel. However, the goals of the program and the specific application forms and surveys remain the same. The number of estimated respondents for Attachment #1 Short-Term Research Experience Program to Unlock Potential (STEP-UP) Application and #2 STEP-UP Student Feedback Form in the burden table has decreased by 1,400 and 75 respectively, which has decreased the overall burden hour estimate by 908 hours from 2,557 to 1,649. Subsequently, the overall burden cost to the public has decreased by $8,970. The federal cost, while slightly increased due to a change in the GS scale, has decreased as contractors were not used after the initial creation of the collection instruments in the last revision.

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Annual Cost to Federal Government: $128,086

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/05/2024

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