Information Collection

Network of Minority Health Research Investigators (NMRI) Enrollment Form

IC 238836 under ICR 202405-0925-002 · OMB 0925-0748.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction
Form 1 Network of Minority Health Research Investigators (NMRI) Enrollment Form	Form and Instruction
1 Enrollment Form (5) Network of Minority Health Research Investigators (NMRI) Enrollment Form.pdf	Form and Instruction
1 Enrollment Form (5) Network of Minority Health Research Investigators (NMRI) Enrollment Form.pdf	Form and Instruction

IC Title:

Agency IC Tracking Number:

Is this a Common Form? No

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	Enrollment Form	(5) Network of Minority Health Research Investigators (NMRI) Enrollment Form.pdf		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title: NIH Privacy Act Systems of Record 09-25-0014, âClinical Research: Student Records, HHS/NIH/OD/OIR/OE,â

FR Citation: 67 FR 60742

Number of Respondents: 200

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
	Approved	Previously Approved
Annual Number of Responses for this IC	200	200
Annual IC Time Burden (Hours)	50	50
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
No associated records found

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