DERT Climate Assessment (NIEHS)

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery (NIH)

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0925-0648 can be found here:

Documents and Forms

Document Name Document Type
Form 1 DERT Climate Assessment (NIEHS) Form
1 NIEHS DERT Climate Assessment NIEHS DERT Climate Survey Screenshots.docx Form
Fast Track Template- NIEHS DERT Climate Survey.docx fast track for NIEHS DERT Climate Survey IC Document

Information Collection (IC) Details

IC Title:	DERT Climate Assessment (NIEHS)	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	1	NIEHS DERT Climate Assessment	NIEHS DERT Climate Survey Screenshots.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Health Care Services

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 70	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	70	70
Annual IC Time Burden (Hours)	12	12
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
fast track for NIEHS DERT Climate Survey	Fast Track Template- NIEHS DERT Climate Survey.docx	12/22/2020

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