[PHIC] Public Health Law Fellowship Program

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form 0920-23DP PHL Fellowship Host Site Supervisor Interview	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Host Site Supervisor Interview	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Host Site End-of-Program Survey	Form and Instruction	New	Available
Form 0920-23DP PHL Fellowship Host Site End-of-Program Survey	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Host Site Welcome	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Host Site Welcome Survey	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Host Site Application	Form and Instruction	New	Available
Form 0920-23DP PHL Fellowship Host Site Application	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Alumni Survey	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellowship Alumni Survey	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellow Focus Group	Form and Instruction	New	Available
Form 0920-23DP PHL Fellow Focus Group	Form and Instruction	New	Repair queued
Form 0920-23DP Att.H-1_PHLFellowPost_WordVersion	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellow End-of-Program Survey	Form and Instruction	New	Available
Form 0920-23DP PHL Fellow Welcome Survey	Form and Instruction	New	Available
Form 0920-23DP PHL Fellow Welcome Survey	Form and Instruction	New	Repair queued
Form 0920-23DP PHL Fellow Application	Form and Instruction	New	Available
Form 0920-23DP PHL Fellow Application	Form and Instruction	New	Repair queued
Att.F-3_PHLFellowWelcome_InvitationEmail.docx	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.I-3_PHLFellowAlum_InvitationEmail.docx	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.K-3_PHLHostWelcome_InvitationEmail.docx	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.L-3_PHLHostPost_InvitationEmail.docx	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.M-2_PHLHostSupervisorInterview_InvitationEmail.docx	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.F-2_PHLFellowWelcome_Screenshot.pdf	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.E-2_PHLFellowApp_Screenshot.pdf	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.D_eClearance Determination.pdf	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.C_PIA_2022_02-02-2023-signed.pdf	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.A-2 PL 117-2.pdf	Supplementary Document	Uploaded 2023-10-13	Repair queued
Att.A-1_Public Health Service Act.pdf	Supplementary Document	Uploaded 2023-10-13	Repair queued
PHLF ICR_SSB_09192023.docx	Supporting Statement B	Uploaded 2023-10-13	Repair queued
PHLF ICR_SSA_09192023_10242023_clean.docx	Supporting Statement A	Uploaded 2023-10-30	Repair queued

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
262802	PHL Fellowship Host Site Supervisor Interview	Form and Instruction	New	PHL Fellowship Host Site Supervisor Interview
262802	PHL Fellowship Host Site Supervisor Interview	Form and Instruction	New
262800	PHL Fellowship Host Site End-of-Program Survey	Form and Instruction	New	PHL Fellowship Host Site End-of-Program Survey
262800	PHL Fellowship Host Site End-of-Program Survey	Form and Instruction	New
262798	PHL Fellowship Host Site Welcome Survey	Form and Instruction	New	PHL Fellowship Host Site Welcome
262798	PHL Fellowship Host Site Welcome Survey	Form and Instruction	New
262797	PHL Fellowship Host Site Application	Form and Instruction	New	PHL Fellowship Host Site Application
262797	PHL Fellowship Host Site Application	Form and Instruction	New
262796	PHL Fellowship Alumni Survey	Form and Instruction	New	PHL Fellowship Alumni Survey
262796	PHL Fellowship Alumni Survey	Form and Instruction	New
262795	PHL Fellow Focus Group	Form and Instruction	New	PHL Fellow Focus Group
262795	PHL Fellow Focus Group	Form and Instruction	New
262793	PHL Fellow End-of-Program Survey	Form and Instruction	New	Att.H-1_PHLFellowPost_WordVersion
262793	PHL Fellow End-of-Program Survey	Form and Instruction	New
262792	PHL Fellow Welcome Survey	Form and Instruction	New	PHL Fellow Welcome Survey
262792	PHL Fellow Welcome Survey	Form and Instruction	New
262791	PHL Fellow Application	Form and Instruction	New	PHL Fellow Application
262791	PHL Fellow Application	Form and Instruction	New

ICR Details

OMB Control No: 0920-1426	ICR Reference No: 202310-0920-006
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CDC	Agency Tracking No: 0920-23DP
Title: [PHIC] Public Health Law Fellowship Program
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 12/19/2023
Retrieve Notice of Action (NOA)	Date Received in OIRA: 10/31/2023
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	12/31/2026	36 Months From Approved
Responses	610	0	0
Time Burden (Hours)	149	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: This fellowship was developed to train and provide experiential learning to current students and early career professionals in public health law and policy. The purpose of this data collection is to assess the quality and value of the Public Health Law Fellowship Program (PHL Fellowship) through the collection of information from two key stakeholder groups: host site supervisors and fellows.

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Authorizing Statute(s): None

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:
	88 FR 19849	03/24/2023
30-day Notice:	Federal Register Citation:	Citation Date:
	88 FR 69635	10/06/2023
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 9

table that charts list of burden

IC Title	Form No.	Form Name
PHL Fellow Application	0920-23DP	PHL Fellow Application
PHL Fellow End-of-Program Survey	0920-23DP	Att.H-1_PHLFellowPost_WordVersion
PHL Fellow Focus Group	0920-23DP	PHL Fellow Focus Group
PHL Fellow Welcome Survey	0920-23DP	PHL Fellow Welcome Survey
PHL Fellowship Alumni Survey	0920-23DP	PHL Fellowship Alumni Survey
PHL Fellowship Host Site Application	0920-23DP	PHL Fellowship Host Site Application
PHL Fellowship Host Site End-of-Program Survey	0920-23DP	PHL Fellowship Host Site End-of-Program Survey
PHL Fellowship Host Site Supervisor Interview	0920-23DP	PHL Fellowship Host Site Supervisor Interview
PHL Fellowship Host Site Welcome Survey	0920-23DP	PHL Fellowship Host Site Welcome

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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	610	0	0	610	0	0
Annual Time Burden (Hours)	149	0	0	149	0	0
Annual Cost Burden (Dollars)	0	0	0	0	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: This is a new collection requesting three years of approval for 149 annual burden hours.

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Annual Cost to Federal Government: $5,525

Does this IC contain surveys, censuses, or employ statistical methods? No

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.     No

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.     No

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: 10/31/2023

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