Information Collection

2026 Health Disparities Research Institute (HDRI)

IC 279191 under ICR 202509-0925-001 · OMB 0925-0740.

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form 1 Application 2026 Health Disparities Research Institute (HDRI)	Form
1 Application 2026 HDRI Application Revised (02-24-26).docx	Form
HDRI Generic Template (APPL) 02.24.26.docx Template	IC Document

IC Title:

Agency IC Tracking Number:

IC Status: New

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	1				Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 20

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	20	20
Annual IC Time Burden (Hours)	1	1
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
Template		02/24/2026

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

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