PHAP Host Site Supervisor Survey

Public Health Associate Program (PHAP) Assessment of Quality and Value.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1078 can be found here:

Documents and Forms

Document Name Document Type
Form 0920-1078 PHAP Host Site Supervisor Survey Form and Instruction
0920-1078 PHAP Host Site Supervisor Survey Attachment E_PHAP Host Site Supervisor Survey Screen Shots.pdf Form and Instruction

Information Collection (IC) Details

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

Is this a Common Form? No		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	0920-1078	PHAP Host Site Supervisor Survey	Attachment E_PHAP Host Site Supervisor Survey Screen Shots.pdf	NA	Yes	Yes	Fillable Fileable

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title: 09-20-0161 - Records of Health Professionals in Disease Prevention and Control Training Programs	FR Citation: 51 FR 42485

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
No associated records found

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