PHAP Host Site Supervisor Survey

Data Collection for CDC Fellowship Programs

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1163 can be found here:

Documents and Forms

Document Name Document Type
PHAP Host Site Supervisor Survey Form
PHAP Host Site Supervisor Survey Attachment C_PHAP Host Site Supervisor Survey_Web Version_updated 032317....pdf Form
PHAP Host Site Supervisor Survey - word Attachment B_PHAP Host Site Supervisor Survey_Word Version_updated 03231....docx Form
SSA+SSB_PHAP Host Site Supervisor Survey_3.15.17.docx Request for Approval - SSA- SSB IC Document
Attachment D_PHAP Host Site Supervisor Survey_Email Invitation_031517.docx Invitation Email IC Document
Attachment E_PHAP Host Site Supervisor Survey_Reminder Email_031517.docx Reminder Email IC Document
Attachment F_PHAP Host Site Supervisor Survey_Reminder Email_031517.docx Reminder Email IC Document
Attachment G_PHAP Host Site Supervisor Survey_Reminder Email_031517.docx Reminder Email IC Document
Attachment A_PHAP Host Site Supervisor Survey Respondent Information_031....docx Respondent Description IC Document
Non-Research Determination_PHAP Host Site Supervisor Survey.pdf Non-research Determination IC Document

Information Collection (IC) Details

IC Title:	PHAP Host Site Supervisor Survey	Agency IC Tracking Number:	17AAL

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	none	PHAP Host Site Supervisor Survey	Attachment C_PHAP Host Site Supervisor Survey_Web Version_updated 032317....pdf		Yes	Yes	Fillable Fileable
Form	none	PHAP Host Site Supervisor Survey - word	Attachment B_PHAP Host Site Supervisor Survey_Word Version_updated 03231....docx		Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

Number of Respondents: 400	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
Annual Number of Responses for this IC	400	400
Annual IC Time Burden (Hours)	133	133
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
Request for Approval - SSA- SSB	SSA+SSB_PHAP Host Site Supervisor Survey_3.15.17.docx	03/23/2017
Invitation Email	Attachment D_PHAP Host Site Supervisor Survey_Email Invitation_031517.docx	03/23/2017
Reminder Email	Attachment E_PHAP Host Site Supervisor Survey_Reminder Email_031517.docx	03/23/2017
Reminder Email	Attachment F_PHAP Host Site Supervisor Survey_Reminder Email_031517.docx	03/23/2017
Reminder Email	Attachment G_PHAP Host Site Supervisor Survey_Reminder Email_031517.docx	03/23/2017
Respondent Description	Attachment A_PHAP Host Site Supervisor Survey Respondent Information_031....docx	03/23/2017
Non-research Determination	Non-Research Determination_PHAP Host Site Supervisor Survey.pdf	03/23/2017

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