Information Collection

Inform NIH About Harassment or Discrimination Concerns

IC 255943 under ICR 202605-0925-003 · OMB 0925-0777.

Documents and Forms

Document Name Document Type
Form 1 Form Inform NIH About Harassment or Discrimination Concerns Form
1 Form website images with required statement .docx Form

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Inform NIH About Harassment or Discrimination Concerns	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	Form	website images with required statement .docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 240	Number of Respondents for Small Entity: 0

Affected Public: Private Sector	Private Sector: Businesses or other for-profits, Not-for-profit institutions

Percentage of Respondents Reporting Electronically: 100 %

	Requested	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	240	240
Annual IC Time Burden (Hours)	60	60
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.

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