Fellowship Management System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0765 Attachment_2-Original FMS_Application_Module	Form	New	Available
FMS Host Site Module	Form and Instruction	Unchanged	Available
FMS Application Module	Form and Instruction	Unchanged	Available
Change Justification OMB Control Number 0920-0765 FMS.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2017-03-22	Available
Final OMB Control Number 0920-0765 Fellowship Management System Change Request.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2015-10-01	Available
Attachment_7-Public_Comment_Response_to_60dayFRN.docx	Supplementary Document	Uploaded 2014-12-01	Available
Attachment_8-Research_Determination_Memo_Final.pdf	Supplementary Document	Uploaded 2014-12-01	Available
Attachment_6-Requested_Changes.docx	Supplementary Document	Uploaded 2014-12-01	Available
Attachment_1_Authorizing_Legislation-PH_Service_Act.docx	Supplementary Document	Uploaded 2014-12-01	Available
Attachment_2_60-Day-FRN-Vol79-No186-25Sep2014_Labeled.pdf	Supplementary Document	Uploaded 2014-12-01	Available
Supporting_Statement_B-FMS_no0920-0765_rev-2014_Subm_11-25-2014.docx	Supporting Statement B	Uploaded 2014-12-01	Available
Supporting_Statement_A-FMS_no0920-0765_rev-2014_Subm_04-03-2015.docx	Supporting Statement A	Uploaded 2015-04-03	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
226159	PMR/F Fellowship Applicants	Form	New	Attachment_2-Original FMS_Application_Module
214088	2014 FMS Host Site Module - PHAP Host Site Example	Form and Instruction	Unchanged	FMS Host Site Module
214087	2014 FMS Alumni Directory - EIS Alumni Directory Example	Instruction	Unchanged
214086	2014 FMS Application Module - EIS Application Example	Form and Instruction	Unchanged	FMS Application Module

ICR Details

OMB Control No: 0920-0765	ICR Reference No: 201703-0920-011
Status: Historical Active	Previous ICR Reference No: 201509-0920-009
Agency/Subagency: HHS/CDC	Agency Tracking No: 18896
Title: Fellowship Management System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 03/23/2017
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/23/2017
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	04/30/2018	04/30/2018	04/30/2018
Responses	3,781	0	3,751
Time Burden (Hours)	4,450	0	4,390
Cost Burden (Dollars)	0	0	0

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Abstract: The purpose of this change request is for OMB approval of proposed modifications to accommodate changing needs of the fellowship program that reflect evolving fellowship eligibility requirements. Specifically, this change request will support collection of previously identified data elements from an estimated 30 new respondents who are nonfederal applicants to PMR/F in the FMS application module. It will also collect limited new data elements from those 30 applicants, if they elect to participate in a PMR/F program designed for fellows who retain their existing employment in a state, tribal, local, and territorial (STLT) agency and conduct training-in-place.

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 57557	09/25/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	79 FR 71103	12/01/2014
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 4

table that charts list of burden

IC Title	Form No.	Form Name
2014 FMS Alumni Directory - EIS Alumni Directory Example
2014 FMS Application Module - EIS Application Example	NA	FMS Application Module
2014 FMS Host Site Module - PHAP Host Site Example	NA	FMS Host Site Module
PMR/F Fellowship Applicants	0920-0765	Attachment_2-Original FMS_Application_Module

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	3,781	3,751	0	30	0	0
Annual Time Burden (Hours)	4,450	4,390	0	60	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The purpose of this change request is for OMB approval of proposed modifications to accommodate changing needs of the fellowship program that reflect evolving fellowship eligibility requirements. Specifically, this change request will support collection of previously identified data elements from an estimated 30 new respondents who are nonfederal applicants to PMR/F in the FMS application module. It will also collect limited new data elements from those 30 applicants

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Annual Cost to Federal Government: $1,056,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 03/23/2017

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