Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)

Forms and Documents

Document Name	Status
Form 11 NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form Form and Instruction	Unchanged
Form 3 STEP-UP Participant Survey form Form and Instruction	Unchanged
Form 13 NIH/NHMA Feedback Form Form and Instruction	Unchanged
Form 12 NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application Form and Instruction	Unchanged
Form 10 NIH/NMA Feedback Form Form and Instruction	Unchanged
Form 9 NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application Form and Instruction	Unchanged
Form 8 NMRI Mentor-Mentee Agreement Form Form and Instruction	Unchanged
Form 7 NMRI Survey Form Form	Modified
Form 6 NMRI Evaluation Form Form and Instruction	Unchanged
Form 5 Network of Minority Health Research Investigators (NMRI) Enrollment Form Form and Instruction	Unchanged
Form 4 Diversity Summer Research Training Program (DSTRP) Feedback Form Form and Instruction	Unchanged
Form 2 STEP-UP Student Feedback Form Form and Instruction	Unchanged
Form 1 Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application Form and Instruction	Unchanged
(7) NMRI Survey Form - Original with strikethrough.docx Supplementary Document	2020-09-01
NIDDK OMHRC Change Memo 0925-0748 Final.docx Justification for No Material/Nonsubstantive Change	2020-09-01
pub 30-day FRN 2020-09693.pdf Supplementary Document	2020-05-20
OMHRC Supporting Statement A 2020.05.20 Final.docx Supporting Statement A	2020-05-20
(13) PIA NIDDK On Site Web Apps.pdf Supplementary Document	2019-12-09
(12) Privacy Act Notification Memo.pdf Supplementary Document	2019-12-09

IC Document Collections

IC ID	Document Title	Status
241916	NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form Form and Instruction	Unchanged
241914	STEP-UP Participant Survey form Form and Instruction	Unchanged
238843	NIH/NHMA Feedback Form Form and Instruction	Unchanged
238842	NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application Form and Instruction	Unchanged
238841	NIH/NMA Feedback Form Form and Instruction	Unchanged
238840	NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application Form and Instruction	Unchanged
238839	NMRI Mentor-Mentee Agreement Form Form and Instruction	Unchanged
238838	NMRI Survey Form Form	Modified
238837	NMRI Evaluation Form Form and Instruction	Unchanged
238836	Network of Minority Health Research Investigators (NMRI) Enrollment Form Form and Instruction	Unchanged
238835	Diversity Summer Research Training Program (DSTRP) Feedback Form Form and Instruction	Unchanged
238834	STEP-UP Student Feedback Form Form and Instruction	Unchanged
238833	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application Form and Instruction	Unchanged

ICR Details

OMB Control No: 0925-0748	ICR Reference No: 202009-0925-001
Status: Active	Previous ICR Reference No: 202005-0925-001
Agency/Subagency: HHS/NIH	Agency Tracking No:
Title: Office of Minority Health Research Coordination (OMHRC) Research Training and Mentor Programs Applications (NIDDK)
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 09/24/2020
	Date Received in OIRA: 09/01/2020
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	08/31/2023	08/31/2023	08/31/2023
Responses	7,114	0	7,114
Time Burden (Hours)	2,557	0	2,557
Cost Burden (Dollars)	0	0	0

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Abstract: The information collection activity is necessary to determine the eligibility and quality of potential awardees for traineeships and mentorships in the National Institute of Diabetes and Digestive and Kidney Diseases’ Office of Minority Health Research Coordination programs.

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Authorizing Statute(s): US Code: 42 USC 241 and 282(b)(13) Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 55318	10/16/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 26980	05/06/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 13

IC Title	Form No.	Form Name
Network of Minority Health Research Investigators (NMRI) Enrollment Form	5	Network of Minority Health Research Investigators (NMRI) Enrollment Form
Diversity Summer Research Training Program (DSTRP) Feedback Form	4	DSTRP Feedback Form
NMRI Survey Form	7	NMRI Survey form -clean version
NMRI Mentor-Mentee Agreement Form	8	NMRI Mentor-Mentee Agreement Form
NIH/National Medical Association (NMA) Academic Career Fellow Travel Awards Application	9	NIH NMA Academic Career Fellow Travel Awards Application
NIH/NMA Academic Career Development Workshop Contact Information and Feedback Form	11	NMA Academic Career Development Workshop Contact Info and Feedback
NIH/National Hispanic Medical Association (NHMA) Academic Career Fellow Travel Awards Application	12	NIH NHMA Academic Career Fellow Travel Awards Application
NIH/NMA Feedback Form	10	NIH NMA Feedbacl Form
NIH/NHMA Feedback Form	13	NIH NHMA Feedback Form
STEP-UP Participant Survey form	3	STEP-UP Participant survey form
Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application	1	Short-Term Research Experience for Underrepresented Persons (STEP-UP) Application
STEP-UP Student Feedback Form	2	STEP-UP Student Feedback Form
NMRI Evaluation Form	6	NMRI Evaluation Form

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ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	7,114	7,114	0	0	0	0
Annual Time Burden (Hours)	2,557	2,557	0	0	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $160,517

Does this IC contain surveys, censuses, or employ statistical methods? No

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 09/01/2020

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