CDC Fellowship Programs Assessments

Data Collection for CDC Fellowship Programs

⚠️ Notice: This information collection may be referencing outdated material.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

Documents and Forms

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

Information Collection (IC) Details

IC Title:	CDC Fellowship Programs Assessments	Agency IC Tracking Number:	0920-21BN

IC Status: New

Obligation to Respond: Voluntary

CFR Citation:

Information Collection 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 %

	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

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.