APIH Fellowship Program Orientation Survey

Generic Clearance for the Collection of Qualitative Feedback on Agency Service Delivery

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1050 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1050 APIH Fellowship Program Orientation Survey Form
0920-1050 APIH - ASPPH ORIENTATION SURVY ATTACHMENT 1_ APIH FELLOWSHIP ASPPH ORIENTATION SURVEY.pdf Form
0920-1050 APIH - AACN ORIENTATON SURVEY ATTACHMENT 2 APIH FELLOWSHIP AACN ORIENTATION SURVEY.pdf Form
ATTACHMENT 3 APIH_ASPPH_Orientation Survey_Inv_Email.docx ASPPH Fellows Invitation Email IC Document
ATTACHMENT 4 APIH_AACN_ Orientation Survey_Inv_Email.docx AACN Fellows Invitation Email IC Document
GenIC Req_0920-1050_APIH Orienatation Survey.docx Request for Approval IC Document
SSA fast track revision.docx Supporting Statement A IC Document
SSB fast track revision.docx Supporting Statement B IC Document
SSA_New_Requirements_0920-1050_2018_APIH Orientation Survey.docx Requirement for Clearance IC Document

Information Collection (IC) Details

IC Title:	APIH Fellowship Program Orientation Survey	Agency IC Tracking Number:	0920-1050-19NK

IC Status: New

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	0920-1050	APIH - ASPPH ORIENTATION SURVY	ATTACHMENT 1_ APIH FELLOWSHIP ASPPH ORIENTATION SURVEY.pdf		Yes	Yes	Fillable Fileable
Form	0920-1050	APIH - AACN ORIENTATON SURVEY	ATTACHMENT 2 APIH FELLOWSHIP AACN ORIENTATION SURVEY.pdf		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 30	Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	30	30
Annual IC Time Burden (Hours)	3	3
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
ASPPH Fellows Invitation Email	ATTACHMENT 3 APIH_ASPPH_Orientation Survey_Inv_Email.docx	01/16/2019
AACN Fellows Invitation Email	ATTACHMENT 4 APIH_AACN_ Orientation Survey_Inv_Email.docx	01/16/2019
Request for Approval	GenIC Req_0920-1050_APIH Orienatation Survey.docx	01/16/2019
Supporting Statement A	SSA fast track revision.docx	01/16/2019
Supporting Statement B	SSB fast track revision.docx	01/16/2019
Requirement for Clearance	SSA_New_Requirements_0920-1050_2018_APIH Orientation Survey.docx	01/16/2019

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