View Information Collection (IC)

View Information Collection (IC)

View Information Collection (IC)

IC Title:	Health Disparities Research Institute (HDRI) (NIMHD)	Agency IC Tracking Number:

IC Status: New

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 and Instruction	1	Application	Final 2023 HDRI Application Form (11-2-22).docx		Yes	Yes	Fillable Fileable

Federal Enterprise Architecture Business Reference Module

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 250	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to New Statute	Program Change Due to Agency Discretion	Change Due to Adjustment in Agency Estimate	Change Due to Potential Violation of the PRA	Previously Approved
Annual Number of Responses for this IC	250	0	250	0	0	0
Annual IC Time Burden (Hours)	104	0	104	0	0	0
Annual IC Cost Burden (Dollars)	0	0	0	0	0	0

Documents for IC

Title	Document	Date Uploaded
sub-study or HDRI application	sub-study template 2023HD_1.docx	11/04/2022
Privacy Act Memo	Privacy Act Memo NIMHDH_1.PDF	11/04/2022
PIA	PIA NIMHDG_1.PDF	11/04/2022

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