Fellowship Management System

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-0765 FMS 2.0 Activity Tracking Module (2020)	Form and Instruction	Unchanged	Available
Form 0920-0765 Activity Tracking	Form and Instruction	Unchanged	Repair queued
Form 0920-0765 FMS Application Module 2020 (sections 12.2 - 12.3.3)	Form and Instruction	Unchanged	Available
Form 0920-0765 Reference Letters for Fellowship Applicants	Form and Instruction	Unchanged	Repair queued
Form 0920-0765 FMS 2.0 Application Module - 13.6 with Prompt Options for EIS Writing Samples	Form and Instruction	Unchanged	Available
Form 0920-0765 FMS Application Writing Samples (Subset Applicants)	Form and Instruction	Unchanged	Repair queued
FMS Host Site Module (2020-revised June 2021)	Form and Instruction	Modified	Available
FMS Host Site Module	Form and Instruction	Modified	Repair queued
FMS 2.0 Alumni Tracking Module (2020)	Form and Instruction	Unchanged	Available
FMS Alumni Directory	Form and Instruction	Unchanged	Repair queued
FMS Application Module (2020-revised June 2021)	Form and Instruction	Modified	Available
Fellowship Applications	Form and Instruction	Modified	Repair queued
Attachment D_Screenshots for Host Site Module-June 2021.docx	Supplementary Document	Uploaded 2021-06-08	Repair queued
Attachment C_ Screenshots for Application Module-June 2021.docx	Supplementary Document	Uploaded 2021-06-08	Repair queued
OMB Change Request - 0920-0765 - June 2021 R1.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-06-08	Repair queued
OMB Change Request - 0920-0765 - Spring 2021_passback 2.docx	Justification for No Material/Nonsubstantive Change	Uploaded 2021-03-16	Repair queued
SSB_01312020.docx	Supporting Statement B	Uploaded 2020-01-31	Available
0920-0765 Supporting Statement A_revised 3-31-2020.docx	Supporting Statement A	Uploaded 2020-03-31	Repair queued
Attachment_8_PIA.pdf	Supplementary Document	Uploaded 2020-01-28	Repair queued
Attachment_7_Research_Determination_Memo_FMS.pdf	Supplementary Document	Uploaded 2020-01-28	Repair queued
Attachment_2_60 Day FRN.pdf	Supplementary Document	Uploaded 2020-01-28	Repair queued
Attachment 1_Public Health Service Act.docx	Supplementary Document	Uploaded 2020-01-28	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
239669	Activity Tracking	Form and Instruction	Unchanged	FMS 2.0 Activity Tracking Module (2020)
239669	Activity Tracking	Form and Instruction	Unchanged
239668	Reference Letters for Fellowship Applicants	Form and Instruction	Unchanged	FMS Application Module 2020 (sections 12.2 - 12.3.3)
239668	Reference Letters for Fellowship Applicants	Form and Instruction	Unchanged
232804	FMS Application Writing Samples (Subset Applicants)	Form and Instruction	Unchanged	FMS 2.0 Application Module - 13.6 with Prompt Options for EIS Writing Samples
232804	FMS Application Writing Samples (Subset Applicants)	Form and Instruction	Unchanged
214088	FMS Host Site Module	Form and Instruction	Modified	FMS Host Site Module (2020-revised June 2021)
214088	FMS Host Site Module	Form and Instruction	Modified
214087	FMS Alumni Directory	Form and Instruction	Unchanged	FMS 2.0 Alumni Tracking Module (2020)
214087	FMS Alumni Directory	Form and Instruction	Unchanged
214086	Fellowship Applications	Form and Instruction	Modified	FMS Application Module (2020-revised June 2021)
214086	Fellowship Applications	Form and Instruction	Modified

ICR Details

OMB Control No: 0920-0765	ICR Reference No: 202106-0920-003
Status: Historical Active	Previous ICR Reference No: 202103-0920-006
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-21FQ
Title: Fellowship Management System
Type of Information Collection: No material or nonsubstantive change to a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 07/01/2021
Retrieve Notice of Action (NOA)	Date Received in OIRA: 06/09/2021
Terms of Clearance: Previous terms continue: CDC will provide OMB a report in advance of any future approvals that addresses how race and ethnicity data is being implemented and used; such a report should include an analysis of demographic statistics and a discussion of how the data is feeding back into program evaluation and implementation including, but not limited to, recruitment and retention efforts.

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	03/31/2023	03/31/2023	03/31/2023
Responses	9,708	0	9,708
Time Burden (Hours)	5,773	0	5,552
Cost Burden (Dollars)	586,324	0	550,826

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Abstract: This is a change request for the Fellowship Management System (FMS). It describes minor changes to the FMS Application Module and the FMS Host Site Module, proposed in June 2021. Changes apply to the following fellowship programs: Preventive Medicine Residency and Fellowship (PMR/F), Population Health Training in Place Program (PH-TIPP), Public Health Informatics Fellowship Program (PHIFP), CDC Steven M. Teutsch Prevention Effectiveness Fellowship (PEF), and the Future Leaders in Infections and Global Health Threats (FLIGHT).

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Authorizing Statute(s): US Code: 42 USC 301 Name of Law: Public Health Service Act
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	84 FR 44313	08/23/2019
30-day Notice:	Federal Register Citation:	Citation Date:
	85 FR 5664	01/31/2020
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 6

table that charts list of burden

IC Title	Form No.	Form Name
Activity Tracking	0920-0765	FMS 2.0 Activity Tracking Module (2020)
FMS Alumni Directory	n/a	FMS 2.0 Alumni Tracking Module (2020)
FMS Application Writing Samples (Subset Applicants)	0920-0765	FMS 2.0 Application Module - 13.6 with Prompt Options for EIS Writing Samples
FMS Host Site Module	n/a	FMS Host Site Module (2020-revised June 2021)
Fellowship Applications	n/a	FMS Application Module (2020-revised June 2021)
Reference Letters for Fellowship Applicants	0920-0765	FMS Application Module 2020 (sections 12.2 - 12.3.3)

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	9,708	9,708	0	0	0	0
Annual Time Burden (Hours)	5,773	5,552	0	221	0	0
Annual Cost Burden (Dollars)	586,324	550,826	0	35,498	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: Minor changes are requested which will increase the estimated burden per response approximately 5 minutes for the Applicant Module and 5 minutes for the Host Site Module for applicants to selected fellowship programs.

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Annual Cost to Federal Government: $465,133

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Does this ICR request any personally identifiable information (see OMB Circular No. A-130 for an explanation of this term)? Please consult with your agency's privacy program when making this determination.     Yes

Does this ICR include a form that requires a Privacy Act Statement (see 5 U.S.C. §552a(e)(3))? Please consult with your agency's privacy program when making this determination.     Yes

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? No

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/09/2021

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