National Environmental Public Health Internship Program (NEPHIP) Outcome Assessment

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⚠️ Notice: This information collection may be referencing outdated material.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
Form 0920-1163 National Environmental Public Health Internship Program (NEPHIP) Outcome Assessment Form and Instruction
0920-1163 Assessment Instrument Web version 2_Attachment_A_NEPHIPAssessmentInstrument_WebVersion_revised.pdf Form and Instruction
1_GenIC_NEPHIPAssessment.docx GenIC Assessment Template IC Document
3_Attachment_B_NEPHIPAssessmentInstrument_WordVersion.docx Assessment Instrument Word version IC Document
4_Attachment_C_NEPHIPAssessment_Announcement.docx Announcement IC Document
5_Attachment_D_NEPHIPAssessment_EmailInvitation.docx Email Invitation IC Document
6_Attachment_E_NEPHIPAssessment_ReminderEmail1.docx Reminder Email 1 IC Document
7_Attachment_F_NEPHIPAssessment_ReminderEmail2.docx Reminder Email 2 IC Document
8_Attachment_G_NEPHIPAssessment_ReminderEmail3.docx Reminder Email 3 IC Document
9_Attachment_H_NEPHIPAssessment_HSRdetermination_revised.pdf HSR Determination IC Document

Information Collection (IC) Details

IC Title:	National Environmental Public Health Internship Program (NEPHIP) Outcome Assessment	Agency IC Tracking Number:	0920-1163-19BKN

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 and Instruction	0920-1163	Assessment Instrument Web version	2_Attachment_A_NEPHIPAssessmentInstrument_WebVersion_revised.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: 128	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	128	128
Annual IC Time Burden (Hours)	21	21
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

Title	Document	Date Uploaded
GenIC Assessment Template	1_GenIC_NEPHIPAssessment.docx	07/01/2019
Assessment Instrument Word version	3_Attachment_B_NEPHIPAssessmentInstrument_WordVersion.docx	07/01/2019
Announcement	4_Attachment_C_NEPHIPAssessment_Announcement.docx	07/01/2019
Email Invitation	5_Attachment_D_NEPHIPAssessment_EmailInvitation.docx	07/01/2019
Reminder Email 1	6_Attachment_E_NEPHIPAssessment_ReminderEmail1.docx	07/01/2019
Reminder Email 2	7_Attachment_F_NEPHIPAssessment_ReminderEmail2.docx	07/01/2019
Reminder Email 3	8_Attachment_G_NEPHIPAssessment_ReminderEmail3.docx	07/01/2019
HSR Determination	9_Attachment_H_NEPHIPAssessment_HSRdetermination_revised.pdf	07/01/2019

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