Information Collection

CDC Fellowship Programs Assessments

IC 244969 under ICR 202011-0920-006 · OMB 0920-1163.

⚠️ Notice: This information collection may be referencing outdated material. More recent filings for OMB 0920-1163 can be found here:

Documents and Forms

Documents and forms in this information collection
Document Name	Document Type
Form Mentor Survey CDC Fellowship Programs Assessments	Form and Instruction
Mentor Survey 0920-21BN AttachmentD_MentorSurvey_GenIC_PPEO.pdf	Form and Instruction
Mentor Interview R 0920-21BN AttachmentE_Mentor_Interview_Recruitment_Form_GenIC_PPEO.pdf	Form and Instruction
Alumni Survey 0920-21BN AttachmentF_AlumniSurvey_GenIC_PPEO.pdf	Form and Instruction
Alumni Interview R 0920-21BN AttachmentG_Alumni_Interview_Recruitment_Form_GenIC_PPEO.pdf	Form and Instruction
Alumni Interview 0920-21BN AttachmentH_Alumni_Interview_GenIC_PPEO.docx	Form and Instruction
PPEO Evaluation Fellowship_Request_GenIC_CLEAN.docx GenIC Request	IC Document
AttachmentC_Followup_Email_GenIC_PPEO.docx Follow-up Email	IC Document
PPEO Evaluation Fellowship Project Determination Description.pdf Project Determination Description	IC Document
PPEO Project Determination Approval.pdf PPEO Project Determination Approval	IC Document
AttachmentB_Recruitment_EMail_GenIC_PPEO.docx Recruitment Email	IC Document

IC Title:

CDC Fellowship Programs Assessments

Agency IC Tracking Number:

0920-21BN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection Instruments:

table that charts list of instruments
Document Type	Form No.	Form Name	Instrument File	Available Electronically?	Can Be Submitted Electronically?	Electronic Capability
Form and Instruction	Mentor Survey	0920-21BN	AttachmentD_MentorSurvey_GenIC_PPEO.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Mentor Interview Recruitment Form	0920-21BN	AttachmentE_Mentor_Interview_Recruitment_Form_GenIC_PPEO.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Alumni Survey	0920-21BN	AttachmentF_AlumniSurvey_GenIC_PPEO.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Alumni Interview Recruitment Form	0920-21BN	AttachmentG_Alumni_Interview_Recruitment_Form_GenIC_PPEO.pdf	Yes	Yes	Fillable Fileable
Form and Instruction	Alumni Interview	0920-21BN	AttachmentH_Alumni_Interview_GenIC_PPEO.docx	Yes	Yes	Fillable Fileable

Line of Business: Health

Subfunction: Public Health Monitoring

Privacy Act System of Records

Title:

FR Citation:

Number of Respondents: 340

Number of Respondents for Small Entity: 0

Affected Public: Individuals or Households

Percentage of Respondents Reporting Electronically: 100 %

table that charts list of burden
	Approved	Program Change Due to Agency Discretion
Annual Number of Responses for this IC	340	340
Annual IC Time Burden (Hours)	75	75
Annual IC Cost Burden (Dollars)	0	0

Documents for IC

table that charts IC Documents
Title	Document	Date Uploaded
GenIC Request	PPEO Evaluation Fellowship_Request_GenIC_CLEAN.docx	12/17/2020
Follow-up Email	AttachmentC_Followup_Email_GenIC_PPEO.docx	12/17/2020
Project Determination Description	PPEO Evaluation Fellowship Project Determination Description.pdf	12/17/2020
PPEO Project Determination Approval	PPEO Project Determination Approval.pdf	12/17/2020
Recruitment Email	AttachmentB_Recruitment_EMail_GenIC_PPEO.docx	12/17/2020

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