Non-substantive change request 5.2.2019

Non-substantive Change Request
OMB Control Number 0920-0765
Fellowship Management System

Application and Host Site Modules
Preventive Medicine Residency and Fellowship

Date Submitted: April 19, 2019

This is a change request for the Center for Disease Control and Prevention (CDC) Fellowship Management System (FMS). The web-based FMS collects information electronically, from candidates (including the public) applying to CDC fellowship programs, public health agencies wishing to host fellows, and alumni of the fellowship programs. FMS is an efficient and effective electronic system for collecting information from potential candidates, processing the fellowship training program applications, and collecting assignment proposals from public health agencies and organizations interested in hosting fellows. FMS is a robust flexible framework and has been successfully tailored for various CDC fellowships that allows for OMB modifications to accommodate the changing needs of the fellowship programs that reflect evolving fellowship eligibility requirements.

The purpose of this change request is for OMB approval of proposed modifications to accommodate changing needs of the Preventive Medicine Residency and Fellowship (PMR/F) fellowship program for two of the FMS modules, the Application Module and the Host Site Module.

Change Request for the Application Module: The change request to the application module will support collection of previously identified data elements from new respondents (i.e., nonfederal applicants to PMR/F) in the FMS application module. It will also collect limited new data elements from those applicants who 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. The details of these changes are described below, and depicted both in Table B and Attachment 2 (Screen Shots for Modifications titled: Attachment 2_CR_App_ScreenShots) and Attachment 3 (FMS Application Module).

Changes are based on and address feedback received from applicants and from STLT health partners during PMR/F site visits and discussions with potential applicants. These changes support the PMR/F training program’s efficiency and effectiveness, and allow for information collection to accommodate necessary changes in the fellowship eligibility criteria. The specific changes from the FMS application module reflect both the use of the FMS application module for PMR/F, and the addition of questions for applicants to the training-in-place version of the fellowship, in which respondents outline details about where they will be training in place. Combined, these changes will enhance CDC’s review and applicant selection and fellowship assignment processes to better meet the needs of the public health workforce.

The approved FMS application has an average burden time per response of 1.75 hours (OMB No. 0920-0765, Supporting Statement A). The proposed PMR/F application module that includes the changes was tested by six (6) CDC staff and external partners, timed, and found that completion of the module results in no additional time per respondent, resulting in the same total average burden time per response of 1.75 hours. The proposed changes do not substantively impact the burden.

Change Request for the Host Site Module: This change request will support collection of limited new data elements from federal and non-federal sites applying to host PMR/F learners in the FMS host site module. The details of these changes are described below, and depicted both in Table C and Attachments 4 (Screen Shots for Modifications titled: Attachment 4_CR_HS_ScreenShots) and Attachment 5 (FMS_Host_Site_ Module).

Changes are based on and address feedback received from existing PMR/F host sites during PMR/F site visits and informal discussions with host sites applying to host a PMR/F learner. These changes support the PMR/F training program’s efficiency and effectiveness, and allow for information collection to accommodate necessary changes in the host sites eligibility criteria. The specific changes from the FMS application module reflect both the use of the FMS host site module for PMR/F, and the addition of new questions for host sites. Combined, these changes will enhance CDC’s review and fellowship assignment processes to better meet the needs of the public health workforce.

The approved FMS host site application module has an average burden time per response of 1.5 hours (OMB No. 0920-0765, Supporting Statement A). The proposed PMR/F host site application module that includes the changes was tested by six (6) CDC staff and external partners, timed, and found that completion of the module results stayed within this 1.5 hours. The proposed changes do not substantively impact the burden.

Estimated Annualized Burden Hours (FMS Application and Host Site Modules)

Type of respondents	Form	Number of respondents	Frequency of Response	Average Burden Time per Response (in hours)	Average total Response Burden (in hours)
Fellowship applicants	FMS Application Module	1991	1	1.75	3485
Public Health Agency or Organization Staff	FMS Host Site Module	408	1	1.5	612
Total		3931			4556

Table A: Fellowship Use of FMS Modules

FMS Application Module	FMS Host Site Module	FMS Alumni Directory Module
EIS	EIS	EIS
LLS	PHAP	Hubert
PEF	PMR/F
PHIF	LLS
Epi-Elect, Fall and Spring Rotations
Hubert
PHAP
PMR/F

Table B: Proposed Changes to the FMS Application Module for the PMR/F Fellowship

EIS Application (Page Name)	Current Question/Item	Requested Change for PMR/F application
Attachment 2 – OMB Change Request PMR/F Screenshots Page 4, 6.2 Program Eligibility Section Figure 6.2.c.6 PMR/F Program Eligibility (specific for PMR/F) Attachment 3– FMS Application Module Page 22 6.2 Program Eligibility Section Figure 6.2 c. PMR/F Program Eligibility	Please indicate the program to which you are applying.	Change response: Delete: “Preventive Medicine Residency” Add: “12-month Preventive Medicine Residency” “24-month Preventive Medicine Residency (needs MPH)” “24-month Preventive Medicine Residency (does not need MPH)”
Attachment 2 – OMB Change Request PMR/F Screenshots Page 3, 6.2 Program Eligibility Section Figure 6.2.c.3 PMR/F Program Eligibility (specific for PMR/F) Attachment 3 – FMS Application Module Page 22 6.2 Program Eligibility Section Figure 6.2 c. PMR/F Program Eligibility	None	New Text: Add the following response language if an applicant does not meet eligibility criteria: You are not eligible at this time to apply to the CDC Preventive Medicine Residency or Fellowship. Review PMR/F eligibility requirements on the PMR/F website. If you feel this is an error, please feel free to e-mail the program at [email protected].
Attachment 2 – OMB Change Request PMR/F Screenshots Page 4 5.2 Citizenship Status Section Figure 5.2-a.1 Country of Citizenship (specific for PMR/F) Attachment 3– FMS Application Module Page 16 5.2 Citizenship Status Section Figure 5.2 a. Country of Citizenship	Please indicate the Country of your citizenship	New Question: Please indicate the country of your birth Allow the following change for PMR/F applicants:
Attachment 2 – OMB Change Request PMR/F Screenshots Page 3, 8.2 Work Experience Section Figure 8.2.a.1 (specific for PMR/F) Attachment 3 – FMS Application Module Page 37 8.2 Work Experience Section Figure 8.2a	Job Duties/Responsibilities and Accomplishments	New Text: Please upload your EIS CAL report Add upload option to decrease burden of manually entering all this information (as a report already exists for this standard information):
Attachment 2 – OMB Change Request PMR/F Screenshots Page 2, 8.2 Work Experience Section Figure 8.2.a.1 (specific for PMR/F) Attachment 3 – FMS Application Module Page 37 8.2 Work Experience Section Figure 8.2a	Job Duties/Responsibilities and Accomplishments	Creates separate response options for each of the below items for those who are not EIS officers or alumni (as EIS alumni just upload a report their EIS accomplishments in this section using the request noted above): PMR/F applicants must complete 2 or more years of applied epidemiology experience outside of graduate studies that demonstrate mastery of the Epidemic Intelligence Service (EIS) Core Activities of Learning to be considered eligible for PMR/F. Please enter all applicable information to describe your experience with each of the below CAL requirements. The PMR/F Selection Committee will review this information to determine your eligibility to apply for this program. Your applied epidemiologic experience must include: Conduct or participate in a field investigation of a potentially serious public health problem that requires a timely response Design, conduct, and interpret an epidemiologic analysis Evaluate a public health surveillance system Give an in-depth public health talk on your original work or in your field of study Write a scientific manuscript for a peer-reviewed journal Communicate complex scientific concepts to a lay audience Provide epidemiology support to a public health agency
Attachment 2 – OMB Change Request PMR/F Screenshots Page 4 13.1 Letters of Recommendation Page Section Figure 13.1.d (specific for PMR/F) Attachment 3 – FMS Application Module Page 48 13.1 Letters of Recommendation Page Section Figure 13.1.a Letters of Recommendation Page	None	Add New Text: The PMR/F selection committee will only accept electronic signatures on the Letters of Recommendation that can be validated through Adobe Acrobat software.
Attachment 2 – OMB Change Request PMR/F Screenshots Page 5, 7.2 Clinical Training Section Figure 7.2 a.1 Clinical Training Section (specific for PMR/F) Attachment 3 – FMS Application Module Page 27 7.2 Clinical Training Section Figure 7.2 a. Clinical Training Section	None	Add New Text: Please upload your Residency Completion Certificate (file upload)
Attachment 2 – OMB Change Request PMR/F Screenshots Page 3 6.2c Program Eligibility Section Figure 6.2.c.5 (specific for PMR/F) Attachment 3 – FMS Application Module Page 20 6.2 Program Eligibility Section Figure 6.2 c. PMR/F Program Eligibility	None	New Question: Do you intend to seek certification by the American Board of Preventive Medicine? Response (Yes/No)
Attachment 2 – OMB Change Request PMR/F Screenshots Page 3 6.2c Program Eligibility Section Section 6.2.c.4 (specific for PMR/F) Attachment 3 – FMS Application Module Page 22 6.2 Program Eligibility Section Figure 6.2 c. PMR/F Program Eligibility	None	New Question: What personnel system are you currently in? Responses (Federal Employee - Title 42, Federal Employee - Title 5, Federal Employee - U.S. Public Health Service, Federal Employee – Military, Not a current Federal Employee)
Attachment 2 – OMB Change Request PMR/F Screenshots Page 3 6.2c Program Eligibility Section Section 6.2.c.4 (specific for PMR/F) Attachment 3 – FMS Application Module Page 22 6.2 Program Eligibility Section Figure 6.2 c. PMR/F Program Eligibility	None	New Question: If “Federal Employee - U.S. Public Health Service” or “Federal Employee – Military” What is your current temporary rank? Responses (O1,O2,O3,O4,O5,O6,O7)
Attachment 2 – OMB Change Request PMR/F Screenshots Page 3 6.2c Program Eligibility Section Section 6.2.c.4 (specific for PMR/F) Attachment 3 – FMS Application Module Page 22 6.2 Program Eligibility Section Figure 6.2 c. PMR/F Program Eligibility	None	New Question: If “Federal Employee - Title 42,” “Federal Employee - Title 5,” “Federal Employee – Military,” or “Not a current Federal Employee” Have you applied or do you plan on applying to be a Commissioned Officer in the U.S. Public Health Service within the next 6 months? (Y/N) If yes, what is the status of your application (Pending Application, Accepted, Under Review, Rejected) If “Accepted” what is the date of your Commission? (Date field)

Table C: Proposed Changes to the FMS Host Site Module for the PMR/F Fellowship

PHAP Application (Page Name)	Current Question/Item	Requested Change for PMR/F application
Attachment 5 Page 22, Section 7, Table 7.2-a	Population Description	Change Text: Allow PMR/F application to use “learner” in place of “associate”
Attachment 4 – OMB Host Site Change Request PMR/F Screenshots Page 2, 8.1 Public Health Agency Statement Section Figure 8.1 a.1 Public Health Agency Statement Page (specific for PMR/F) Attachment 5 – FMS Host Site Module Page 25 8.1 Public Health Agency Statement Section Figure 8.1 a. Public Health Agency Statement Page	Public Health Agency Statement Section	Change Text: Allow alternate language specific for PMR/F instead of PHAP language: Provide a narrative of 750 words or less that describes the program’s mission and vision, population served, connections with universities and community stakeholders, and experience with supporting long-term trainees.
Attachment 4 - Host Site Change Request PMR/F Screenshots Page 2, 8.1 Public Health Agency Statement Section Figure 8.1 a.2 Public Health Agency Statement Page (specific for PMR/F) Attachment 5 FMS Host Site Module Page 25 8.1 Public Health Agency Statement Section Figure 8.1 a. Public Health Agency Statement Page	None	New Question: Add question specific for PMR/F (free text field 750 word limit): Title: Work Environment & Administrative Support Describe the physical environment (e.g. workstation), policy development support, administrative support, statistical support, clinical site supervision, and travel funding availability.
Attachment4 - Host Site Change Request PMR/F Screenshots Page 2-3, 8.1 Public Health Agency Statement Section Figure 8.1 a.3 Public Health Agency Statement Page (specific for PMR/F) Attachment 5 FMS Host Site Module Page 25 8.1 Public Health Agency Statement Section Figure 8.1 a. Public Health Agency Statement Page	No existing item in FMS host site application for PHAP	New Question: Add language specific for PMR/F: If matched with a learner, are you able to support the travel and registration costs for the learner to: Attend a congressional orientation training in Washington DC? Attend the American College of Preventive Medicine (ACPM) annual conference? Response option (Yes/ No) If Response = “No” Display: You are not eligible at this time to be a Host Site for the CDC Preventive Medicine Residency & Fellowship Program. Review PMR/F Host Site eligibility requirements on the PMR/F website. If you feel this is an error, please feel free to e-mail the program at [email protected]. Note: Please refer to the PMR/F website to get more details about these trainings.
Attachment 4- Host Site Change Request PMR/F Screenshots Page 3, 8.1 Public Health Agency Statement Section Figure 8.1 a.4 Public Health Agency Statement Page (specific for PMR/F) Attachment 5 FMS Host Site Module Page 25 8.1 Public Health Agency Statement Section Figure 8.1 a. Public Health Agency Statement Page	None	New Question: Add language specific for PMR/F: For locations outside of Atlanta, GA or Washington, DC: Can your host site support clinical responsibilities of a resident approximately 1 day per week? (e.g. a clinic, an attending physician, training environment, credentialing support, clinic orientation and training, access to health records) Response options (Yes / No) If Response = “No” Please select from the following options: We can only host a PMR/F Fellow (who have no clinic responsibilities) We would like to host either a resident or fellow but need help identifying an appropriate location
Attachment 4- Host Site Change Request PMR/F Screenshots Page 4, 8.1 Public Health Agency Statement Section Figure 8.1 a.5 Public Health Agency Statement Page (specific for PMR/F) Attachment 5 FMS Host Site Module Page 25 8.1 Public Health Agency Statement Section Figure 8.1 a. Public Health Agency Statement Page	None	New Question: Add question specific to PMR/F (free text field 750 word limit): Learning Opportunities: Describe the opportunities to gain leadership and management experience.
Attachment 4 - Host Site Change Request PMR/F Screenshots Page 4, 9.2 Program Information Figure 9.2-d Additional Position Details (additional response options specific for PMR/F) Attachment 5 FMS Host Site Module Page 27-29 9.2 Program Information Additional Position Details Table 9.2a	Additional response options specific for PMR/F	New Question: Add additional position details for PMR/F: Section header and text: PMR/F Performance Requirements: Provide a detailed project description for each of the PMR/F performance requirements that can be accomplished in 11 months that meet the PMR/F learning objectives. Note that PMR/F projects should emphasize building leadership and management skills in the following population health topics: public health and healthcare integration, community health, health system transformation, and social determinants of health. Response categories (free-text boxes with 750-word limit for each of the following responses) Program evaluation Policy analysis or development Population health improvement Project management Grant proposal evaluation and development

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