Information Collection

Alumni Fellows Survey

IC 212643 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⚠️ Notice: This information collection may be referencing outdated material.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

Documents and forms in this information collection
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

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:

table that charts list of 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 %

table that charts list of burden
	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

table that charts IC Documents
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.