Exit survey Part 1

National Eye Institute’s Intramural Research ProgramApplication Form for electronic Individual Development Plan (eIDP)

Documents and Forms

Document Name Document Type
Form 1 Exit survey Part 1 Form
1 Survey Data Collection Instrument - Exit Survey Part 1.docx Form

Information Collection (IC) Details

IC Title:	Exit survey Part 1	Agency IC Tracking Number:

Is this a Common Form? No		IC Status: Modified

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	Survey	Data Collection Instrument - Exit Survey Part 1.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title: 09–25–0014, “Clinical Research; Student Records, HHS/PHS/NIH/OD/OIR/OE.”	FR Citation: 67 FR 67042

Number of Respondents: 150	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Previously Approved
Annual Number of Responses for this IC	150	150
Annual IC Time Burden (Hours)	13	13
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

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.