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Medical Students
THE NATIONAL INSTITUTE ON DRUG ABUSE'S (NIDA) STUDY OF SUBSTANCE ABUSE DOC.COM MODULE PROJECT
OMB: 0925-0635
IC ID: 197526
OMB.report
HHS/NIH
OMB 0925-0635
ICR 201111-0925-001
IC 197526
( )
Documents and Forms
Document Name
Document Type
Form 2
Medical Students
Form
2 Survey 2 for Medical Students (Post-Survey 1 or 2)
6 - NIDA OMB B2-2 Survey 2 for Medical Students (Post Survey 1 or 2) 2-28-11 sh.docx
Form
1 Medical Students Pre-Survey
Attachment B2-1 Survey 1 for Medical Students (Pre Survey 1 or 2) 3-30-11 sh[1].doc
Form
Attachment A1 Email Invitation to Medical Students 3-30-11 sh.docx
Attachment A1 Email Invitation to Medical Students 3-30-11 sh
IC Document
Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh.docx
Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh
IC Document
Information Collection (IC) Details
View Information Collection (IC)
IC Title:
Medical Students
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
2
Survey 2 for Medical Students (Post-Survey 1 or 2)
6 - NIDA OMB B2-2 Survey 2 for Medical Students (Post Survey 1 or 2) 2-28-11 sh.docx
Yes
Yes
Fillable Printable
Form
1
Medical Students Pre-Survey
Attachment B2-1 Survey 1 for Medical Students (Pre Survey 1 or 2) 3-30-11 sh[1].doc
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:
400
Number of Respondents for Small Entity:
0
Affected Public:
Individuals or Households
Percentage of Respondents Reporting Electronically:
0 %
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
1,600
0
0
0
0
1,600
Annual IC Time Burden (Hours)
272
0
0
0
0
272
Annual IC Cost Burden (Dollars)
0
0
0
0
0
0
Documents for IC
Title
Document
Date Uploaded
Attachment A1 Email Invitation to Medical Students 3-30-11 sh
Attachment A1 Email Invitation to Medical Students 3-30-11 sh.docx
04/26/2011
Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh
Attachment A12 End of Study Email Medical Students in Control Group 4-7-11sh.docx
04/26/2011
Blank fields in records indicate information that was not collected or not collected electronically prior to July 2006.