Trainee Feedback Form for NIGMS Programs

​​OMB#: 0925-0648  |  Expiration Date: ​6/30/2024 

Privacy Act Notification:​
This statement is provided pursuant to the Privacy Act of 1974 (5 U.S.C. § 552a): Collection of this information is authorized under 42 U.S.C. 203, 241, 289l-1 and 44 U.S.C. 3101, and Section 301 and 493 of the Public Health Service Act. The principal purpose for which the information will be used is to improve existing or develop new program policies based on the experiences of trainees supported by NIGMS’ Division of Training, Workforce Development, and Diversity (TWD). Completing the form and providing your contact information is voluntary, however, if you decline to provide your contact information, you will not be able to receive a response to your comments. The information you provide will be included in a Privacy Act system of records and will be used and may be disclosed for the purposes and routine uses described and published in the following System of Records Notice (SORN): 09-25-0156​ Records of Participants in Programs and Respondents in Surveys Used to Evaluate Programs of the Public Health Service.

Reporting Burden:
Public reporting burden for this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information.  An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a currently valid OMB control number.  Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to: NIH, Project Clearance Branch, 6705 Rockledge Drive, MSC 7974, Bethesda, MD 20892-7974, ATTN: PRA (0925-0648).  Do not return the completed form to this address. 

Feedback Form Instructions:​
We welcome your valuable input as we refine our existing programs and develop new programs to meet the emerging needs in biomedical research train​ing. For example, if you have comments to improve our programs, or you would like to recognize an outstanding program for their training activities, please reach out.

All feedback is welcomed and appreciated across the educational and career​ stages.
​To leave comments, please use the feedback form below. Many of the fields are optional if you wish to remain anonymous. If you would like a response, please check "yes" under the "response requested" option and provide your contact information.​​ Please do not put any Personally Identifiable Information (PII) or sensitive information (SI), such as Social Security Numbers, Date of Birth, Medical condition(s), or financial information, in the open field text boxes. The information you share cannot be guaranteed as confidential. If you have any concerns regarding your PII, please email NIGMSTrainingMail@nigms.nih.gov.

If you need to report a concern abou​t a form of​​​ misconduct​, such as harassment, discrimination, or research misconduct, ​please find the appropriate NIH contac​​​ts and information here: https://grants.nih.gov/help/report-a-concern​.
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NIGMS.Internet - TWDFeedbackForm


* Fields marked with an asterisk are required.

NIGMS TWD Programs:
Career Stage:
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Institution:
* Comment Box:
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