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⚠️ Notice: This information collection may be referencing outdated material.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
PHAP Host Site Supervisor Survey Form and Instruction
Attachment B_PHAP Host Site Supervisor Survey_FINAL.docx Other-WORD version of survey to faci
Attachment B_PHAP Host Site Supervisor Survey_FINAL.docx Other-WORD version of survey to faci
PHAP Host Site Supervisor Survey Attachment F_PHAP Host Site Supervisor Survey Screen Shots_FINAL.pdf Form and Instruction
PHAP Host Site Supervisor Survey Attachment F_PHAP Host Site Supervisor Survey Screen Shots_FINAL.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: Modified

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	n/a	PHAP Host Site Supervisor Survey	Attachment F_PHAP Host Site Supervisor Survey Screen Shots_FINAL.pdf		Yes	Yes	Fillable Fileable
Other-WORD version of survey to facilitate review of content			Attachment B_PHAP Host Site Supervisor Survey_FINAL.docx		No		Paper Only

Line of Business: Workforce Management

Subfunction: Training and Employment

Privacy Act System of Records
Title:	FR Citation:

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	Previously Approved
Annual Number of Responses for this IC	400	0	400
Annual IC Time Burden (Hours)	133	0	133
Annual IC Cost Burden (Dollars)	4,672	4,672	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.