Alumni Fellows Survey

Survey of Current and Alumni SAMHSA Fellows of the Minority Fellowship Program (MFP)

⚠️ Notice: This information collection may be referencing outdated material.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 Alumni Fellows Sur Alumni Fellows Survey Form and Instruction
Alumni Fellows Sur Alumni Fellows Survey Attachment B Alumni consent and surveyrevised_Update_12.15.15.docx Form and Instruction

Information Collection (IC) Details

IC Title:	Alumni 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	Alumni Fellows Survey	Alumni Fellows Survey	Attachment B Alumni 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: 1,440	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	1,440	780	660
Annual IC Time Burden (Hours)	1,080	638	442
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.