Information Collection

Current Fellows Survey

IC 189380 under ICR 201603-0930-007 · OMB 0930-0304.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0930-0304 can be found here:

Documents and Forms

Document Name Document Type
Form Current Fellows Su Current Fellows Survey Form and Instruction
Current Fellows Su Current Fellows Survey Attachment A Current consent and surveyrevised_Update_12.15.15.docx Form and Instruction

Information Collection (IC) Details

View Information Collection (IC)

IC Title:	Current Fellows Survey	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 and Instruction	Current Fellows Survey	Current Fellows Survey	Attachment A Current consent and surveyrevised_Update_12.15.15.docx		Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 428	Number of Respondents for Small Entity: 0

Affected Public: State, Local, and Tribal Governments

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion	Previously Approved
Annual Number of Responses for this IC	428	300	128
Annual IC Time Burden (Hours)	180	138	42
Annual IC Cost Burden (Dollars)	0	0	0

Documents for IC

Title	Document	Date Uploaded
No associated records found

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