FMS Host Site Module

Attachment 2

OMB Control Number 0920-0765
Fellowship Management System

Non-substantive Change Request

Proposed changes to the CDC Public Health Associate program (PHAP)
FMS Host Site Module
Date Submitted: September 4, 2015

PHAP Host Site Module

Screen shots of modified questions

Table of Contents

1 Public Health Agency Details: Contact Information 3

2 Public Health Agency Details: Population Description 4

3 Public Health Agency Details: Organizational Structure 5

4 Public Health Agency Statement 6

5 Assignment Details 7

6 Program Details 8

7 Appendix A 9

Add Activity 9

8 Appendix B 11

Add Training 11

Training Types 11

9 Appendix C 12

Primary Supervisor Information 12

10 Appendix D 13

Secondary Supervisor Information 13

11 Appendix E 14

CIO Categorical Program Areas List 14

1. Public Health Agency Details: Contact Information

1. Click the Primary link to display the primary supervisor entry screen shown in Appendix C.

2. Click the Secondary link to display the secondary supervisor entry screen shown in Appendix D.

3. Allow ability to upload letter or support form in the Director Contact section.

2. Public Health Agency Details: Population Description

1. The Primary Topic field is a dropdown that will include “Other” – see Appendix F for dropdown list

2. Allow ability to select multiple categories for Race, Life Stages and Primary Topic

3. Public Health Agency Details: Organizational Structure

4. Public Health Agency Statement

5. Assignment Details

1. Added column in table to capture the Program Area

6. Program Details

1. Click the Add Activity button to display the Add Activity screen shown in Appendix A.

2. Click the Add Training button to display the Add Training screen shown in Appendix B.

3. Click the Primary link to display the primary supervisor entry screen shown in Appendix C.

4. Click the Secondary link to display the secondary supervisor entry screen shown in Appendix D.

5. Program dropdown will be the list of CIO Categorical Program Areas shown in Appendix E.

7. Appendix A

Add Activity

1. Level of Responsibility dropdown list will include: Team Member, Coordinator, Lead or Other (specify)

8. Appendix B

Add Training

Training Types

• One-on-One

• E-Learning Non-CDC

• Classroom: HD

• Classroom: Outside Sponsor

• E-learning CDC

9. Appendix C

Primary Supervisor Information

10. Appendix D

Secondary Supervisor Information

11. Appendix E

CIO Categorical Program Areas List (the CIO and division will not be visible to the host site but will link to CIO on admin page)

CIO		Categorical Program Area(s)
1.	Center for Surveillance, Epidemiology, and Laboratory Services (CSELS)	Division of Public Health Information Dissemination (DPHID Genomics Community Health Status Indicators (CHSI) Informatics Innovation Unit (IIU) Informatics R&D Laboratory (within IIU) Community Health Assessment for Population Health Improvement  Division of Laboratory Systems Clinical Laboratory Improvement Program Laboratory Sustainability Laboratory Policies and Guidance Division of Health Informatics and Surveillance BioSense Epi Info™ Message Validation, Processing, and Provisioning System (MVPS) NEDSS Base System (NBS) Countermeasure Tracking Systems (CTS) Laboratory Response Network (LRN) Data Exchange Activities Public Health Information Network National Notifiable Diseases Surveillance System (NNDSS) NNDSS Modernization Initiative (NMI) National Syndromic Surveillance Program (NSSP
2.	National Center for Birth Defects and Developmental Disabilities (NCBDDD)	Division of Birth Defects and Developmental Disabilities Autism surveillance and research Newborn Screening - birth defects surveillance and research Congenital Heart Defects Safe medication use during pregnancy Prevention of Fetal Alcohol Spectrum Disorders Learn the Signs Act Early (LTSAE) –  developmental milestones Folic acid-preventable neural tube defects in the United States and globally Division of Human Development and Disabilities Disability and Health State Programs (18).  Healthy behaviors, emergency preparedness, healthcare access and equity issues for people living with disabilities   Disability and Health Data System Complex Chronic Conditions - Muscular Dystrophy, Spina Bifida and Fragile X Early childhood development, Tourette Syndrome and Attention Deficit and Hyperactivity Disorder Early Hearing Detection and Intervention (newborn hearing screening) Division of Blood Disorders Hemophilia, Sickle cell and Von Willebrand Disease Clotting disorders such as venous thromboembolism (VTE)
3.	National Center for Chronic Disease Prevention and Health Promotion (NCCDPHP)	Diabetes prevention/education Physical activity Nutrition Obesity Cardiovascular health (HTN prevention and control, Million Hearts, sodium reduction) Cancer prevention and screening (breast, cervical, skin, prostate, and colorectal) Maternal and infant health (SIDS, teen pregnancy) Smoking prevention and cessation School health Oral health (fluoridation, sealants) Arthritis (Living Well With) Reproductive health
4.	National Center for Emerging and Zoonotic Infectious Diseases (NCEZID)	Advanced molecular detection Antimicrobial resistance and healthcare associated infections Epi and lab capacity program Emerging infectious diseases Food safety Lyme disease National Healthcare Safety Network Prion disease Quarantine Vector-borne diseases All other emerging and zoonotic infectious diseases
5.	National Center for HIV/AIDS, STD, and TB Prevention (NCHHSTP)	STD/HIV TB prevention Viral hepatitis Adolescent and school health
6.	National Center for Immunizations and Respiratory Diseases (NCIRD)	Immunizations Vaccine Preventable Diseases
7.	National Center for Injury Prevention and Control (NCIPC)	Motor vehicle injuries Prescription drug overdoses Growth areas: Child abuse and neglect Older adult falls Sexual violence Youth sports concussions
8.	National Center on Environmental Health (NCEH)	Air pollution and respiratory health Asthma and allergies Bio-monitoring (nutritional status, exposure to environmental chemicals and toxic substances Built Environment/Healthy Community Design (i.e. Transportation, Planning, and Physical Activity) Cancer Chemical Weapons Demilitarization Children’s Environmental Health Climate Change and Health Cruise ship sanitation Emergency Response and/or disaster preparedness Environmental Public Health Tracking (i.e., surveillance of environmental health-related health effects or conditions) Food Safety Hazardous Materials Response Healthy Homes and Lead Poisoning Prevention Indoor/Outdoor Air Quality Newborn Screening and Birth Defects Pest, Vector, and Animal Control Poison Control Public/Private Water Safety and Protection Radiation and Radon Control Regulation, Inspection, and Licensing (e.g. restaurants, pools, campgrounds, hospitals) Reproductive and Birth Outcomes Solid and Hazardous Waste Toxicology
9.	National Institute for Occupational Safety and Health (NIOSH)	Impacts of nanotechnology on workers Cancer, reproductive, and cardiovascular diseases associated with work Economic analysis of safety and health interventions Health and safety of emergency responders Engineering controls Tools for assessing exposure to workplace hazards Conducting workplace investigations of health hazards (Health Hazard Evaluation) Hearing Loss prevention Immune, Dermal, and Infectious diseases associated with work conditions Musculoskeletal disorders and ergonomics Identifying occupational health disparities amongst workers of different backgrounds Personal protective equipment and technology Radiation exposure Respiratory diseases Small-business safety and health The intersection of occupational safety and health with health promotion Traumatic injury at work Work schedules and policies (including shiftwork and long work hours) Work-stress Worker’s compensation Studies and interventions in specific sectors: Agriculture, Forestry and Fishing Construction Healthcare and Social Assistance Manufacturing Mining Oil and Gas Extraction Public Safety Service Industry Transportation, Warehousing and Utilities Wholesale and Retail Trade
10.	Office for State, Tribal, Local and Territorial Support (OSTLTS)	Health department accreditation Tribal health Public health law Public health performance improvement / quality improvement Community health improvement Community health assessments Community health improvement planning Health system transformation Territorial health
11.	Office of Public Health Preparedness and Response (OPHPR)	Community Preparedness Community Recovery Emergency Operations Center (EOC) Coordination Emergency Public Information and Warning Fatality Management Information Sharing Mass Care Medical Countermeasure (MCM) Dispensing MCM Management and Distribution Medical Surge Non-Pharmaceutical Interventions Public Health Laboratory Testing Public Health Surveillance and Epi Investigations Responder Safety and Health Volunteer Management